In Reply Davari et al address an important issue regarding the potential for proposed Supplemental Nutrition Assistance Program (SNAP) eligibility changes to disproportionately impact rural communities and contribute to sudden death. Although the data set we used in our analysis1 did not allow for direct comparisons of SNAP enrollment type or mortality rates on the basis of rural residence, high rates of food insecurity, chronic illness, and poverty are noted in rural communities.2,3 It is possible that loss of financial and nutritional benefits in already-vulnerable rural families might contribute to worsening health and/or longevity. If the proposed SNAP eligibility rollbacks continue, we believe it would be necessary to carefully monitor health outcomes in affected families, including those living in rural areas, to reduce the risk of causing significant harm. Finally, we share the authors’ worries about limiting food supports during the current coronavirus disease 2019 public health emergency and were encouraged by the passage of recent federal legislation to temporarily enhance nutritional assistance programs.4,5
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Peltz A, Rogers S, Garg A. Limiting Supplemental Nutrition Assistance Program Eligibility May Increase Sudden Death—Reply. JAMA Intern Med. 2020;180(9):1260. doi:10.1001/jamainternmed.2020.1915
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