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

  • Cardiovascular disease
  • Published:
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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.

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Abbreviations

CI:

Confidence interval

CT:

Census tract

CVD:

Cardiovascular disease

DSMR:

Directly standardised mortality rate

FFR:

Fast-food restaurant

FVS:

Fruit and vegetable store

ICD:

International Classification of Diseases

MCMA:

Montréal Census Metropolitan Area

RR:

Relative risk

SE:

Standard error

SES:

Socioeconomic status

SIC:

Standard Industry Classification

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Acknowledgments

The authors acknowledge the contributions of Karine Léger, Elisabeth Marks and Abdel Majid Mohamed. This work was funded in part by the Fondation du Centre hospitalier de l’Université de Montréal, Canada Foundation for Innovation (grant #201252, MD) and the Canadian Institutes of Health Research through a Canada Research Chair (Population Health) to MD.

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Authors and Affiliations

  1. Sansom Institute for Health Research, The University of South Australia, City East Campus, North Terrace, GPO Box 2471, Adelaide, SA, 5001, Australia

    Mark Daniel & Catherine Paquet

  2. Department of Medicine, St Vincent’s Hospital, The University of Melbourne, Melbourne, VIC, Australia

    Mark Daniel

  3. Centre de recherche du Centre hospitalier de l’Université de Montréal, Montréal, QC, Canada

    Mark Daniel, Nathalie Auger, Geng Zang & Yan Kestens

  4. Institut national de santé publique du Québec, Montréal, QC, Canada

    Nathalie Auger

  5. Secteur environnement urbain et santé, Direction de santé publique de Montréal, Montréal, QC, Canada

    Yan Kestens

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  1. Mark Daniel
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Correspondence to Mark Daniel.

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Daniel, M., Paquet, C., Auger, N. et al. Association of fast-food restaurant and fruit and vegetable store densities with cardiovascular mortality in a metropolitan population. Eur J Epidemiol 25, 711–719 (2010). https://doi.org/10.1007/s10654-010-9499-4

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  • DOI: https://doi.org/10.1007/s10654-010-9499-4

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