title: The relationship between the supply of fast-food chains and cardiovascular outcomes.
abstract: OBJECTIVE
  To examine the extent to which inter-regional differences in fast-food concentrations account for variations in all-cause mortality and acute coronary syndromes throughout Ontario, Canada.
  
  
  METHODS
  Nine distinct fast-food chains were selected based on top sales data in 2001. The per capita rate of fast-food outlets per region was calculated for each of 380 regions throughout Ontario. Outcome measures, obtained using 2001 vital statistics data and hospital discharge abstracts, included regional per capita mortality rates and acute coronary syndrome hospitalization rates; head trauma served as a comparator. All regional outcomes were adjusted for age, gender, and socio-economic status, and were analyzed as continuous and rank-ordered variables as compared with the provincial average.
  
  
  RESULTS
  Mortality and admissions for acute coronary syndromes were higher in regions with greater numbers of fast-food services after adjustment for risk. Risk-adjusted outcomes among regions intensive in fast-food services were more likely to be high outliers for both mortality (Adjusted Odds Ratio (OR): 2.52, 95% confidence intervals (CI): 1.54 - 4.13, p < 0.001) and acute coronary hospitalizations (Adjusted OR: 2.62, 95% CI 1.42 - 3.59, p < 0.001) compared to regions with low fast-food service intensity. There was no relationship between the concentration of fast-food outlets and risk-adjusted head-trauma hospitalization rates.
  
  
  CONCLUSIONS
  Inter-regional cardiac outcome disparities throughout Ontario were partially explained by fast-food service intensity. Such findings emphasize the need to target health promotion and prevention initiatives to highest-risk communities.
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON. david.alter@ices.on.ca
authors.forename: David A
authors.initials: DA
authors.lastname: Alter
authors.forename: Karen
authors.initials: K
authors.lastname: Eny
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality*; D006259:Craniocerebral Trauma / Q000453:epidemiology; D004041:Dietary Fats / Q000008:administration & dosage*; D005523:Food Supply / Q000145:classification; D005843:Geography; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D016017:Odds Ratio; D009864:Ontario / Q000453:epidemiology; D015995:Prevalence; D012147:Restaurants / Q000145:classification / Q000706:statistics & numerical data*; D018570:Risk Assessment
chemical_list: D004041:Dietary Fats