Research Article|Articles in Press

Time-Varying Food Retail and Incident Disease in the Cardiovascular Health Study


      Natural experiments can strengthen evidence linking neighborhood food retail presence to dietary intake patterns and cardiometabolic health outcomes, yet sample size and follow-up duration are typically not extensive. To complement natural experiment evidence, longitudinal data were used to estimate the impacts of neighborhood food retail presence on incident disease.


      The Cardiovascular Health Study recruited adults aged 65+ years in 1989–1993. Analyses conducted in 2021–2022 included those in good baseline health, with addresses updated annually through the year of death (restricted to 91% who died during >2 decades of cohort follow-up). Baseline and annually updated presence of 2 combined food retail categories (supermarkets/produce markets and convenience/snack focused) was characterized using establishment-level data for 1-km and 5-km Euclidean buffers. Cox proportional hazards models estimated associations with time to each incident outcome (cardiovascular disease, diabetes), adjusting for individual and area-based confounders.


      Among 2,939 participants, 36% with baseline supermarket/produce market presence within 1 km had excess incident cardiovascular disease (hazard ratio=1.12; 95% CI=1.01, 1.24); the association was attenuated and no longer statistically significant after adjustment for sociodemographic characteristics. Adjusted associations were robustly null for time-varying supermarket/produce market or convenience/fast food retail presence across analyses with outcomes of cardiovascular disease or diabetes incidence.


      Food environment changes continue to be studied to provide an evidence base for policy decisions, and null findings in this longitudinal analysis add literature that casts doubt on the sufficiency of strategies targeting food retail presence alone of an elderly cohort for curtailing incident events of clinical importance.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Malambo P
        • Kengne AP
        • De Villiers A
        • Lambert EV
        • Puoane T.
        Built environment, selected risk factors and major cardiovascular disease outcomes: a systematic review.
        PLoS One. 2016; 11 (e0166846)
        • Murphy SL
        • Xu J
        • Kochanek KD
        • Arias E.
        Mortality in the United States, 2017.
        NCHS Data Brief. 2018; (Accessed February 24, 2023): 1-8
        • Hosler AS
        • Rajulu DT
        • Fredrick BL
        • Ronsani AE.
        Assessing retail fruit and vegetable availability in urban and rural underserved communities.
        Prev Chronic Dis. 2008; 5: A123
        • Zenk SN
        • Powell LM
        • Rimkus L
        • et al.
        Relative and absolute availability of healthier food and beverage alternatives across communities in the United States.
        Am J Public Health. 2014; 104: 2170-2178
        • Andreyeva T
        • Blumenthal DM
        • Schwartz MB
        • Long MW
        • Brownell KD.
        Availability and prices of foods across stores and neighborhoods: the case of New Haven, Connecticut.
        Health Aff (Millwood). 2008; 27: 1381-1388
        • Leone AF
        • Rigby S
        • Betterley C
        • et al.
        Store type and demographic influence on the availability and price of healthful foods, Leon County, Florida, 2008.
        Prev Chronic Dis. 2011; 8: A140
        • Jetter KM
        • Cassady DL.
        The availability and cost of healthier food alternatives.
        Am J Prev Med. 2006; 30: 38-44
        • Liese AD
        • Weis KE
        • Pluto D
        • Smith E
        • Lawson A.
        Food store types, availability, and cost of foods in a rural environment.
        J Am Diet Assoc. 2007; 107: 1916-1923
        • Li F
        • Harmer PA
        • Cardinal BJ
        • et al.
        Built environment, adiposity, and physical activity in adults aged 50–75.
        Am J Prev Med. 2008; 35: 38-46
        • Sallis JF
        • Floyd MF
        • Rodríguez DA
        • Saelens BE.
        Role of built environments in physical activity, obesity, and cardiovascular disease.
        Circulation. 2012; 125: 729-737
        • Ezzati M
        • Hoorn SV
        • Rodgers A
        • et al.
        Estimates of global and regional potential health gains from reducing multiple major risk factors [published correction appears in Lancet.
        Lancet. 2003; 362 (2005;365(9453):28): 271-280
        • Lovasi GS
        • Rundle A
        • Bader M
        • Neckerman KM
        Population Health: he Translation of Research to Policy: Case Study 1: Healthy and Unhealthy Food Sources in New York City.
        Milbank Memorial Fund, New York, NY2018 (Published September. Accessed February 24, 2023)
        • Ghosh-Dastidar B
        • Cohen D
        • Hunter G
        • et al.
        Distance to store, food prices, and obesity in urban food deserts.
        Am J Prev Med. 2014; 47: 587-595
        • Allcott H
        • Diamond R
        • Dubé JP
        • Handbury J
        • Rahkovsky I
        • Schnell M.
        Food deserts and the causes of nutritional inequality.
        Q J Econ. 2019; 134: 1793-1844
        • Cummins S
        • Petticrew M
        • Higgins C
        • Findlay A
        • Sparks L.
        Large scale food retailing as an intervention for diet and health: quasi-experimental evaluation of a natural experiment.
        J Epidemiol Community Health. 2005; 59: 1035-1040
        • Cummins S
        • Flint E
        • Matthews SA.
        New neighborhood grocery store increased awareness of food access but did not alter dietary habits or obesity.
        Health Aff (Millwood). 2014; 33: 283-291
        • Dubowitz T
        • Ghosh-Dastidar M
        • Cohen DA
        • et al.
        Diet and perceptions change with supermarket introduction in a food desert, but not because of supermarket use [published correction appears in Health Aff (Millwood).
        Health Aff (Millwood). 2015; 34 (2015;34(12):2205]): 1858-1868
        • Evans AE
        • Jennings R
        • Smiley AW
        • et al.
        Introduction of farm stands in low-income communities increases fruit and vegetable among community residents.
        Health Place. 2012; 18: 1137-1143
        • Ruelas V
        • Iverson E
        • Kiekel P
        • Peters A.
        The role of farmers’ markets in two low income, urban communities.
        J Community Health. 2012; 37: 554-562
        • Leone LA
        • Tripicchio GL
        • Haynes-Maslow L
        • et al.
        Cluster randomized controlled trial of a mobile market intervention to increase fruit and vegetable intake among adults in lower-income communities in North Carolina.
        Int J Behav Nutr Phys Act. 2018; 15: 2
        • An R
        • Maurer G.
        Consumption of sugar-sweetened beverages and discretionary foods among US adults by purchase location.
        Eur J Clin Nutr. 2016; 70: 1396-1400
        • Powell LM
        • Kumanyika SK
        • Isgor Z
        • Rimkus L
        • Zenk SN
        • Chaloupka FJ.
        Price promotions for food and beverage products in a nationwide sample of food stores.
        Prev Med. 2016; 86: 106-113
        • Ravensbergen EA
        • Waterlander WE
        • Kroeze W
        • Steenhuis IH.
        Healthy or unhealthy on sale? A cross-sectional study on the proportion of healthy and unhealthy foods promoted through flyer advertising by supermarkets in the Netherlands.
        BMC Public Health. 2015; 15: 470
        • Lovasi GS
        • Mooney SJ
        • Muennig P
        • DiMaggio C.
        Cause and context: place-based approaches to investigate how environments affect mental health.
        Soc Psychiatry Psychiatr Epidemiol. 2016; 51: 1571-1579
        • Gamba RJ
        • Schuchter J
        • Rutt C
        • Seto EY.
        Measuring the food environment and its effects on obesity in the United States: a systematic review of methods and results.
        J Community Health. 2015; 40: 464-475
        • Fried LP
        • Borhani NO
        • Enright P
        • et al.
        The Cardiovascular Health Study: design and rationale.
        Ann Epidemiol. 1991; 1: 263-276
        • Ives DG
        • Fitzpatrick AL
        • Bild DE
        • et al.
        Surveillance and ascertainment of cardiovascular events. The cardiovascular health study.
        Ann Epidemiol. 1995; 5: 278-285
        • Jacquez GM
        • Slotnick MJ
        • Meliker JR
        • AvRuskin G
        • Copeland G
        • Nriagu J.
        Accuracy of commercially available residential histories for epidemiologic studies.
        Am J Epidemiol. 2011; 173: 236-243
        • Mossey JM
        • Shapiro E.
        Self-rated health: a predictor of mortality among the elderly.
        Am J Public Health. 1982; 72: 800-808
        • Ettinger Jr, WH
        • Fried LP
        • Harris T
        • Shemanski L
        • Schulz R
        • Robbins J.
        Self-reported causes of physical disability in older people: the Cardiovascular Health Study. CHS Collaborative Research Group.
        J Am Geriatr Soc. 1994; 42: 1035-1044
        • Hoehner CM
        • Schootman M.
        Concordance of commercial data sources for neighborhood-effects studies.
        J Urban Health. 2010; 87: 713-725
        • Hirsch JA
        • Winters M
        • Clarke P
        • McKay H.
        Generating GPS activity spaces that shed light upon the mobility habits of older adults: a descriptive analysis.
        Int J Health Geogr. 2014; 13: 51
        • Hirsch JA
        • Moore KA
        • Cahill J
        • et al.
        Business data categorization and refinement for application in longitudinal neighborhood health research: a methodology.
        J Urban Health. 2021; 98: 271-284
        • Marwa WL
        • Radley D
        • Davis S
        • McKenna J
        • Griffiths C.
        Exploring factors affecting individual GPS-based activity space and how researcher-defined food environments represent activity space, exposure and use of food outlets.
        Int J Health Geogr. 2021; 20: 34
        • Moore LV
        • Diez Roux AV
        Associations of neighborhood characteristics with the location and type of food stores.
        Am J Public Health. 2006; 96: 325-331
        • Berger N
        • Kaufman TK
        • Bader MDM
        • et al.
        Disparities in trajectories of changes in the unhealthy food environment in New York City: a latent class growth analysis, 1990–2010.
        Soc Sci Med. 2019; 234112362
        • Sims RV
        • Mujib M
        • Mcgwin Jr, G
        • et al.
        Heart failure is a risk factor for incident driving cessation among community-dwelling older adults: findings from a prospective population study.
        J Card Fail. 2011; 17: 1035-1040
        • Rundle AG
        • Chen Y
        • Quinn JW
        • et al.
        Development of a neighborhood walkability index for studying neighborhood physical activity contexts in communities across the U.S. over the past three decades.
        J Urban Health. 2019; 96: 583-590
        • Logan JR
        • Stults BD
        • Xu Z.
        Validating population estimates for harmonized census tract data, 2000–2010.
        Ann Am Assoc Geogr. 2016; 106: 1013-1029
        • Kerr J
        • Frank L
        • Sallis JF
        • Saelens B
        • Glanz K
        • Chapman J.
        Predictors of trips to food destinations.
        Int J Behav Nutr Phys Act. 2012; 9: 58
        • Wedick NM
        • Ma Y
        • Olendzki BC
        • et al.
        Access to healthy food stores modifies effect of a dietary intervention.
        Am J Prev Med. 2015; 48: 309-317
        • Karpyn A
        • McCallops K
        • Wolgast H
        • Glanz K.
        Improving consumption and purchases of healthier foods in retail environments: a systematic review.
        Int J Environ Res Public Health. 2020; 17: 7524
        • Gittelsohn J
        • Rowan M
        • Gadhoke P.
        Interventions in small food stores to change the food environment, improve diet, and reduce risk of chronic disease.
        Prev Chronic Dis. 2012; 9: E59
        • Shangguan S
        • Afshin A
        • Shulkin M
        • et al.
        A meta-analysis of food labeling effects on consumer diet behaviors and industry practices.
        Am J Prev Med. 2019; 56: 300-314
        • Rummo PE
        • Guilkey DK
        • Ng SW
        • Popkin BM
        • Evenson KR
        • Gordon-Larsen P.
        Beyond supermarkets: food outlet location selection in four U.S. cities over time.
        Am J Prev Med. 2017; 52: 300-310
        • Warren JL
        • Gordon-Larsen P.
        Factors associated with supermarket and convenience store closure: a discrete time spatial survival modelling approach.
        J R Stat Soc Ser A Stat Soc. 2018; 181: 783-802
        • Strachan SM
        • Brawley LR.
        Healthy-eater identity and self-efficacy predict healthy eating behavior: a prospective view.
        J Health Psychol. 2009; 14: 684-695
        • Barrington WE
        • Beresford SA
        • McGregor BA
        • White E.
        Perceived stress and eating behaviors by sex, obesity status, and stress vulnerability: findings from the vitamins and lifestyle (VITAL) study.
        J Acad Nutr Diet. 2014; 114: 1791-1799
        • Shahrin FI
        • Omar N
        • Daud ZA
        • Zakaria NF.
        Factors associated with food choices among elderly: a scoping review.
        Mal J Nutr. 2019; 25: 185-198
        • Stark JH
        • Neckerman K
        • Lovasi GS
        • et al.
        Neighbourhood food environments and body mass index among New York City adults.
        J Epidemiol Community Health. 2013; 67: 736-742
        • Afshin A
        • Peñalvo JL
        • Del Gobbo L
        • et al.
        The prospective impact of food pricing on improving dietary consumption: a systematic review and meta-analysis.
        PLoS One. 2017; 12e0172277
        • Lovasi GS
        • Johnson NJ
        • Altekruse SF
        • et al.
        Healthy food retail availability and cardiovascular mortality in the United States: a cohort study.
        BMJ Open. 2021; 11e048390
        • Cobb LK
        • Appel LJ
        • Franco M
        • Jones-Smith JC
        • Nur A
        • Anderson CA.
        The relationship of the local food environment with obesity: a systematic review of methods, study quality, and results [published correction appears in Obesity (Silver Spring).
        Obesity (Silver Spring). 2015; 23 (2015;23(12):2517–2519]): 1331-1344
        • Vlahov D
        • Galea S
        • Freudenberg N.
        The urban health “advantage”.
        J Urban Health. 2005; 82: 1-4
        • Freudenberg N
        • Galea S
        • Vlahov D.
        Beyond urban penalty and urban sprawl: back to living conditions as the focus of urban health.
        J Community Health. 2005; 30: 1-11
        • Wang H
        • Stokes JE.
        Trajectories of rural-urban disparities in biological risks for cardiovascular disease among Chinese middle-aged and older adults.
        Health Place. 2020; 64102354
        • Richardson AS
        • Meyer KA
        • Howard AG
        • et al.
        Neighborhood socioeconomic status and food environment: a 20-year longitudinal latent class analysis among CARDIA participants.
        Health Place. 2014; 30: 145-153