Wholesome meals retail availability and cardiovascular mortality within the US: a cohort research

BMJ open. 07/09/2021; 11 (7): e048390. doi: 10.1136 / bmjopen-2020-048390.


OBJECTIVE: We investigated the relationship between healthy presence in food retail and cardiovascular mortality, taking socio-demographic characteristics into account. This association could provide information about efforts to maintain or increase local supermarkets or to produce market availability.

DESIGN: Cohort study combining Mortality Disparities in American Communities (individual-level data from the 2008 American Community Survey linked to National Death Index records from 2008 to 2015) and data on retail businesses.

ATTITUDE: In the continental US, area-based sociodemographic and retail characteristics have been linked to place of residence through zip code table area (ZCTA). Instead, sensitivity analyzes used census areas that were restricted to urban or district-based classes or that took into account non-independence with the help of frailty models.

PARTICIPANTS: 2,753,000 people aged 25 and over living in households with fully equipped kitchens, excluding group accommodation.

PRIMARY AND SECONDARY OUTCOMES MEASURES: Cardiovascular mortality (primary) and all-cause mortality (secondary).

RESULTS: 82% had a healthy food retail business (supermarket, grocery store) within their ZCTA. The density of this retail trade was correlated with the density of unhealthy food sources (e.g. fast food, convenience store). In fully adjusted models (with adjustment for gender, age), a healthy presence in food retail 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) related, marital status, date of birth, black race, Hispanic ethnicity, educational level, income, median household income, population density, accessible target density). The zero finding for cardiovascular mortality was consistent across all adaptation strategies, including minimally adapted models (individual demographic data only), sensitivity analyzes in relation to the setting and across gender or household types. However, an unhealthy presence in food retail was associated with increased all-cause mortality (HR: 1.15; 95% CI 1.11 to 1.20).

CONCLUSIONS: This study, which examined food establishments in administrative areas of the United States, did not support the presumed association between the availability of healthy food in retail stores and reduced cardiovascular mortality; an association between unhealthy presence in grocery stores and higher mortality rates was not specific for cardiovascular causes.

PMID: 34244272 | DOI: 10.1136 / bmjopen-2020-048390

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