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Healthy food retail availability and cardiovascular mortality in the United States: a cohort study
Journal article   Open access   Peer reviewed

Healthy food retail availability and cardiovascular mortality in the United States: a cohort study

Gina S. Lovasi, Norman J. Johnson, Sean F. Altekruse, Jana A. Hirsch, Kari A. Moore, Janene R. Brown, Andrew G. Rundle, James W. Quinn, Kathryn Neckerman and David S. Siscovick
BMJ open, v 11(7), pp e048390-e048390
01 Jan 2021
DOI: https://doi.org/10.1136/bmjopen-2020-048390
PMID: 34244272
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1136/bmjopen-2020-048390View
Published, Version of Record (VoR)CC BY V4.0,  Open

Abstract

General & Internal Medicine Life Sciences & Biomedicine Medicine, General & Internal Science & Technology
Objectives We investigated the association of healthy food retail presence and cardiovascular mortality, controlling for sociodemographic characteristics. This association could inform efforts to preserve or increase local supermarkets or produce market availability. Design Cohort study, combining Mortality Disparities in American Communities (individual-level data from 2008 American Community Survey linked to National Death Index records from 2008 to 2015) and retail establishment data. Setting Across the continental US area-based sociodemographic and retail characteristics were linked to residential location by ZIP code tabulation area (ZCTA). Sensitivity analyses used census tracts instead, restricted to urbanicity or county-based strata, or accounted for non-independence using frailty models. Participants 2 753 000 individuals age 25+ living in households with full kitchen facilities, excluding group quarters. Primary and secondary outcome measures Cardiovascular mortality (primary) and all-cause mortality (secondary). Results 82% had healthy food retail (supermarket, produce market) within their ZCTA. Density of such retail was correlated with density of unhealthy food sources (eg, fast food, convenience store). Healthy food retail presence was not associated with reduced cardiovascular (HR: 1.03; 95% CI 1.00 to 1.07) or all-cause mortality (HR: 1.05; 95% CI 1.04 to 1.06) in fully adjusted models (with adjustment for gender, age, marital status, nativity, Black race, Hispanic ethnicity, educational attainment, income, median household income, population density, walkable destination density). The null finding for cardiovascular mortality was consistent across adjustment strategies including minimally adjusted models (individual demographics only), sensitivity analyses related to setting, and across gender or household type strata. However, unhealthy food retail presence was associated with elevated all-cause mortality (HR: 1.15; 95% CI 1.11 to 1.20). Conclusions In this study using food establishment locations within administrative areas across the USA, the hypothesised association of healthy food retail availability with reduced cardiovascular mortality was not supported; an association of unhealthy food retail presence with higher mortality was not specific to cardiovascular causes.

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14 citations in Web of Science
15 citations in Scopus

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UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Public, Environmental & Occupational Health
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