Association of fast-food restaurant and fruit and vegetable store densities with cardiovascular mortality in a metropolitan population.
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.
Daniel
Mark
M
Sansom Institute for Health Research, The University of South Australia, North Terrace, Adelaide, SA, Australia. mark.daniel@unisa.edu.au
Paquet
Catherine
C
Auger
Nathalie
N
Zang
Geng
G
Kestens
Yan
Y
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality*; D057140:Fast Foods / Q000600:supply & distribution*; D005260:Female; D005638:Fruit / Q000600:supply & distribution*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011792:Quebec / Q000453:epidemiology; D014505:Urban Population; D014675:Vegetables / Q000600:supply & distribution*; D055815:Young Adult
Am J Prev Med. 2006 Apr;30(4):333-9
16530621
Public Health Nutr. 2007 Oct;10(10):1005-17
17381942
J Epidemiol Community Health. 2008 Mar;62(3):198-201
18272733
Am J Epidemiol. 2009 Jul 1;170(1):29-36
19429879
Int J Obes (Lond). 2005 Jun;29(6):703-10
15809667
BMC Public Health. 2009 Jun 18;9:192
19538709
Obes Rev. 2008 Nov;9(6):535-47
18346099
Natl Vital Stat Rep. 2001 May 18;49(2):1-32
11381674
Public Health Nutr. 2004 Dec;7(8):1081-8
15548347
Health Place. 2008 Jun;14(2):117-32
17590377
J Epidemiol Community Health. 2004 Mar;58(3):199-207
14966232
J Intern Med. 2008 Apr;263(4):336-52
18312311
J Am Coll Nutr. 2004 Apr;23(2):163-8
15047683
Am J Prev Med. 2006 Apr;30(4):327-332
16530620
Am J Epidemiol. 1997 Jul 1;146(1):48-63
9215223
Ann Neurol. 2009 Aug;66(2):165-70
19743456
J Epidemiol Community Health. 2007 Jun;61(6):491-8
17496257
Environ Health Perspect. 2009 Mar;117(3):442-7
19337520
J Epidemiol Community Health. 2004 Jan;58(1):71-7
14684730
N Engl J Med. 2001 Jul 12;345(2):99-106
11450679
Am J Epidemiol. 2004 Apr 1;159(7):655-62
15033643
Am J Prev Med. 2004 Oct;27(3):211-7
15450633
J Urban Health. 2003 Dec;80(4):569-89
14709706
J Epidemiol Community Health. 1999 Jan;53(1):55-63
10326055
Am J Epidemiol. 2007 Jan 1;165(1):22-6
16973762
Int J Obes (Lond). 2007 Jun;31(6):887-90
17452996
Int J Behav Nutr Phys Act. 2008 Nov 10;5:58
19000319
Public Health Nutr. 2004 Dec;7(8):1089-96
15548348
Am J Epidemiol. 2009 Feb 15;169(4):401-8
19153214
Am J Prev Med. 2009 Jan;36(1):74-81
18977112
Am J Prev Med. 2008 Feb;34(2):127-33
18201642
Can J Public Health. 2009 May-Jun;100(3):189-93
19507720
Can J Public Health. 2005 May-Jun;96(3):173-7
15913078
J Nutr. 2003 Mar;133(3):831S-834S
12612162
Public Health Nutr. 2009 Mar;12(3):397-405
18477414
Am J Prev Med. 2007 Feb;32(2):97-106
17234484
J Epidemiol Community Health. 2003 Mar;57(3):210-7
12594198
Am J Public Health. 2007 Mar;97(3):500-8
17267734
Am J Epidemiol. 2008 Jun 1;167(11):1349-57
18367469
Int J Obes Relat Metab Disord. 2000 Oct;24(10):1353-9
11093299
Am J Public Health. 2005 Jan;95(1):91-7
15623866
Obes Rev. 2003 Nov;4(4):187-94
14649369
Am J Health Promot. 2004 Nov-Dec;19(2):137-43
15559714
Appetite. 2006 Sep;47(2):196-204
16698116
Int J Epidemiol. 1999 Oct;28(5):841-5
10597980
Am J Epidemiol. 2008 Apr 15;167(8):917-24
18304960
Am J Prev Med. 2009 Apr;36(4 Suppl):S124-33
19285203
Am J Public Health. 2002 Nov;92(11):1761-7
12406805
J Epidemiol Community Health. 2005 Dec;59(12):1035-40
16286490
J Epidemiol Community Health. 1998 Jun;52(6):399-405
9764262
Am J Epidemiol. 2007 Feb 1;165(3):279-87
17077168