Association of fast-food restaurant and fruit and vegetable store densities with cardiovascular mortality in a metropolitan population

Abstract

Most studies that link neighbourhoods to disease outcomes have represented neighbourhoods as area-level socioeconomic status. Where objective contextual attributes of urban environments have been measured, few studies of food availability have evaluated mortality as an outcome. We sought to estimate associations between the availability of fast-food restaurants (FFR), fruit and vegetable stores (FVS), and cardiovascular mortality in an urban area. Food business data were extracted from a validated commercial database containing all businesses and services in the Montréal Census Metropolitan Area (MCMA). Mortality data (1999-2003) were obtained for the MCMA (3.4 million residents). Directly standardised mortality rates for cardiovascular deaths (n = 30,388) and non-cardiovascular deaths (all causes - cardiovascular deaths) (n = 91,132) and FFR and FVS densities (n/km²) were analysed for 845 census tracts. Generalised additive models and generalised linear models were used to analyse food source-mortality relationships. FVS density was not associated with cardiovascular or non-cardiovascular mortality (relative risk (RR) = 1.02, 95% confidence interval (CI): 0.76, 1.36, and RR = 1.14, 95% CI: 0.87, 1.50, respectively). Higher FFR density was associated with mortality in bivariate and multivariable analyses. Relative risks of death (95% CI) per 10% increase in FFR density were similar for both cardiovascular and non-cardiovascular mortality: 1.39 (1.19, 1.63) and 1.36 (1.18, 1.57), respectively, accounting for socio-demographic covariates. FFR density is associated with cardiovascular mortality but this relationship is no different in magnitude than that for non-cardiovascular mortality. These results together with null associations between FVS density and mortality do not support a major role for food source availability in cardiovascular outcomes.

Mortality outcomes associated with intake of fast-food items and sugar-sweetened drinks among older adults in the Vitamins and Lifestyle (VITAL) study

“…Additional evidence comes from studies that compare the distribution of fast-food and convenience outlets (which also sell SSD) and mortality across neighbourhoods. Specifically, studies have noted increased risk of total and CVD mortality with greater availability of fast-food outlets in a neighbourhood after adjustment for area-and individual-level demographic characteristics (41,42) . The strengths of the present analysis include its large sample size as well as robust tests for interactions and adjustment for numerous covariates.…”

Association between Activity Space Exposure to Food Establishments and Individual Risk of Overweight

“…Studies have been looking at relations between food environments and food purchasing, diet, or more distal health outcomes like BMI, cardio-vascular outcomes or mortality [2], [3], [4]. But findings are mixed.…”

Validation of presence of supermarkets and fast-food outlets in Copenhagen: case study comparison of multiple sources of secondary data

“…Relatively little is published on the validity and reliability of these sources (1) . In a recent review by Kelly and colleagues (2) , methods used to validate the location of food outlets obtained from secondary data range from list cross-referencing (3)(4)(5)(6) to direct observation (7)(8)(9)(10)(11)(12)(13)(14) . Correspondence between sources was reported as percentage match or agreement (6,7,9,10,13,15) , sensitivity (11)(12)(13) or positive predictive value (PPV) (12,13,16) .…”

“…In a recent review by Kelly and colleagues (2) , methods used to validate the location of food outlets obtained from secondary data range from list cross-referencing (3)(4)(5)(6) to direct observation (7)(8)(9)(10)(11)(12)(13)(14) . Correspondence between sources was reported as percentage match or agreement (6,7,9,10,13,15) , sensitivity (11)(12)(13) or positive predictive value (PPV) (12,13,16) . Validation studies reporting correspondence statistics have generally been performed in North America (3,4,6,(9)(10)(11)(12)14,15,17) or the UK (5,7,13,16) .…”

“…Correspondence between sources was reported as percentage match or agreement (6,7,9,10,13,15) , sensitivity (11)(12)(13) or positive predictive value (PPV) (12,13,16) . Validation studies reporting correspondence statistics have generally been performed in North America (3,4,6,(9)(10)(11)(12)14,15,17) or the UK (5,7,13,16) . To our knowledge, there are no other published validation studies of the food environment elsewhere.…”