Americans who live in poorer, urban areas and those who have less income are least likely to consume healthy food, regardless of their access to it, according to a study published in the American Heart Association’s journal Circulation.

Because neighborhood characteristics and socioeconomic status have been tied to increased risk for cardiovascular disease (CVD) and other health concerns in the past, researchers at Emory University School of Medicine studied 1,421 people living in the Atlanta metropolitan area to determine whether that was due to low access to healthy food or other reasons.

The study’s authors zoned in on food deserts in urban Atlanta—regions where a large chunk of a population doesn’t have access to healthy food within one mile in urban settings and 10 miles in rural ones—focusing on 712 people recruited from the META-Health study and 709 pulled from the Predictive Health study.

Researchers evaluated participants’ demographic data, metabolic profiles, high-sensitivity C-reactive protein levels, oxidative stress markers and arterial stiffness, according to the study. Subjects were an average of 50 years old, and the majority were female.

The Emory team found that compared to those not living in urban food deserts, the cohort recorded higher rates of smoking, hypertension, fasting glucose, body mass index and 10-year risk for CVD. Instead of CVD risk being linked to food access, researchers found it was more heavily tied to income. Living in a low-income area and having low individual household income were independent predictors of CVD, according to the study.

“People living in (food deserts) had a higher prevalence of cardiovascular risk factors, inflammation, oxidative stress and arterial stiffness,” the authors wrote. “These associations are largely driven by area and individual income rather than access to healthy food. The implications of our findings are that at least in urban areas, risk of CVD seems to be associated less with access to healthy food and more with socioeconomic factors. This understanding may help to better tailor resources to affected communities and improve utilization of public health resources.”