Introduction
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.
Methods
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.
Results
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.
Conclusions
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.
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Published online: March 06, 2023
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