Introduction
Cardiovascular disease is the main cause of general and premature death of adults
aged 30–69 years in Brazil and around the world. Unhealthy food environments have
been implicated as one of the factors associated with cardiovascular disease morbimortality
because they affect people's health conditions and nutrition. This study aims to explore
the association between unhealthy food environments (deserts/swamps) and premature
cardiovascular disease mortality in the Brazilian population.
Methods
This is an ecologic study using data from 5,558 Brazilian municipalities in 2016.
The cardiovascular disease mortality data were obtained from the Mortality Information
System of the Ministry of Health. The study on mapping food deserts in Brazil, developed
by the Interministerial Chamber of Food and Nutrition Security, was used to evaluate
the physical dimension of food access. The authors calculated the standardized rates
of premature general and specific cardiovascular disease (stroke and ischemic heart
disease) causes of death in the same period. To characterize food environments, the
density of unprocessed and ultraprocessed foods per 10,000 population in tertiles
was used. Crude and adjusted negative binomial regression models were used to study
the associations of interest.
Results
After the necessary adjustments (human development index, gross domestic product per
capita, unemployment rate, Gini index and Family Health Strategy coverage), it was
found that municipalities with low unprocessed food supply were at the highest risk
of increased mortality among women with ischemic heart disease (rate ratio first tertile:
1.08 [95% CI=1.01, 1.15]). Conversely, the municipalities where there was a greater
offer of ultraprocessed foods showed a higher risk of death from cardiovascular diseases
(rate ratio second tertile: 1.17 [95% CI=1.12, 1.22]; rate ratio third tertile: 1.20
[95% CI=1.14, 1.26]), from strokes (rate ratio second tertile: 1.19 [95% CI=1.13,
1.25]; rate ratio third tertile: 1.22 [95% CI=1.15, 1.30]), and ischemic heart disease
(rate ratio second tertile: 1.19 [95% CI=1.12, 1.25]; rate ratio third tertile: 1.22
[95% CI=1.13, 1.29]).
Conclusions
This study's findings show an increase in the risk of cardiovascular disease, stroke,
and ischemic heart disease mortality, especially in the municipalities where there
was a greater offer of ultraprocessed foods. Initiatives aiming to minimize the effects
of these food environments are urgently needed in the Brazilian context.
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Article info
Publication history
Published online: November 24, 2022
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© 2022 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
