Association of Fast-Food and Full-Service Restaurant Densities With Mortality From Cardiovascular Disease and Stroke, and the Prevalence of Diabetes Mellitus

Mohsen Mazidi, John R Speakman

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Abstract

BACKGROUND: We explored whether higher densities of fast-food restaurants (FFRs) and full-service restaurants are associated with mortality from cardiovascular disease (CVD) and stroke and the prevalence of type 2 diabetes mellitus (T2D) across the mainland United States.

METHODS AND RESULTS: In this cross-sectional study county-level data for CVD and stroke mortality, and prevalence of T2D, were combined with per capita densities of FFRs and full-service restaurants and analyzed using regression. Mortality and diabetes mellitus prevalence were corrected for poverty, ethnicity, education, physical inactivity, and smoking. After adjustment, FFR density was positively associated with CVD (β=1.104, R2=2.3%), stroke (β=0.841, R2=1.4%), and T2D (β=0.578, R2=0.6%) and full-service restaurant density was positively associated with CVD mortality (β=0.19, R2=0.1%) and negatively related to T2D prevalence (β=-0.25, R2=0.3%). In a multiple regression analysis (FFRs and full-service restaurants together in same model), only the densities of FFRs were significant (and positive). If we assume these relationships are causal, an impact analysis suggested that opening 10 new FFRs in a county would lead to 1 extra death from CVD every 42 years and 1 extra death from stroke every 55 years. Repeated nationally across all counties, that would be an extra 748 CVD deaths and 567 stroke deaths (and 390 new cases of T2D) over the next 10 years.

CONCLUSIONS: These results suggest that an increased density of FFRs is associated with increased risk of death from CVD and stroke and increased T2D prevalence, but the maximal impact (assuming the correlations reflect causality) of each individual FFR is small.

CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT03243253.

Original languageEnglish
Article number007651
Number of pages13
JournalJournal of the American Heart Association
Volume7
Issue number11
Early online date25 May 2018
DOIs
Publication statusPublished - 5 Jun 2018

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Food Services
Fast Foods
Restaurants
Diabetes Mellitus
Cardiovascular Diseases
Myocardial Infarction
Mortality
Type 2 Diabetes Mellitus
Stroke
Social Adjustment
Physical Education and Training
Poverty
Causality

Keywords

  • Biomarker
  • End-stage renal disease
  • major adverse cardiac event
  • mortality
  • risk stratification

Cite this

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title = "Association of Fast-Food and Full-Service Restaurant Densities With Mortality From Cardiovascular Disease and Stroke, and the Prevalence of Diabetes Mellitus",
abstract = "BACKGROUND: We explored whether higher densities of fast-food restaurants (FFRs) and full-service restaurants are associated with mortality from cardiovascular disease (CVD) and stroke and the prevalence of type 2 diabetes mellitus (T2D) across the mainland United States.METHODS AND RESULTS: In this cross-sectional study county-level data for CVD and stroke mortality, and prevalence of T2D, were combined with per capita densities of FFRs and full-service restaurants and analyzed using regression. Mortality and diabetes mellitus prevalence were corrected for poverty, ethnicity, education, physical inactivity, and smoking. After adjustment, FFR density was positively associated with CVD (β=1.104, R2=2.3{\%}), stroke (β=0.841, R2=1.4{\%}), and T2D (β=0.578, R2=0.6{\%}) and full-service restaurant density was positively associated with CVD mortality (β=0.19, R2=0.1{\%}) and negatively related to T2D prevalence (β=-0.25, R2=0.3{\%}). In a multiple regression analysis (FFRs and full-service restaurants together in same model), only the densities of FFRs were significant (and positive). If we assume these relationships are causal, an impact analysis suggested that opening 10 new FFRs in a county would lead to 1 extra death from CVD every 42 years and 1 extra death from stroke every 55 years. Repeated nationally across all counties, that would be an extra 748 CVD deaths and 567 stroke deaths (and 390 new cases of T2D) over the next 10 years.CONCLUSIONS: These results suggest that an increased density of FFRs is associated with increased risk of death from CVD and stroke and increased T2D prevalence, but the maximal impact (assuming the correlations reflect causality) of each individual FFR is small.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT03243253.",
keywords = "Biomarker, End-stage renal disease, major adverse cardiac event, mortality, risk stratification",
author = "Mohsen Mazidi and Speakman, {John R}",
note = "Acknowledgments The authors thank Dr Karen Byth for her assistance in the statistical analysis.",
year = "2018",
month = "6",
day = "5",
doi = "10.1161/JAHA.117.007651",
language = "English",
volume = "7",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "11",

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TY - JOUR

T1 - Association of Fast-Food and Full-Service Restaurant Densities With Mortality From Cardiovascular Disease and Stroke, and the Prevalence of Diabetes Mellitus

AU - Mazidi, Mohsen

AU - Speakman, John R

N1 - Acknowledgments The authors thank Dr Karen Byth for her assistance in the statistical analysis.

PY - 2018/6/5

Y1 - 2018/6/5

N2 - BACKGROUND: We explored whether higher densities of fast-food restaurants (FFRs) and full-service restaurants are associated with mortality from cardiovascular disease (CVD) and stroke and the prevalence of type 2 diabetes mellitus (T2D) across the mainland United States.METHODS AND RESULTS: In this cross-sectional study county-level data for CVD and stroke mortality, and prevalence of T2D, were combined with per capita densities of FFRs and full-service restaurants and analyzed using regression. Mortality and diabetes mellitus prevalence were corrected for poverty, ethnicity, education, physical inactivity, and smoking. After adjustment, FFR density was positively associated with CVD (β=1.104, R2=2.3%), stroke (β=0.841, R2=1.4%), and T2D (β=0.578, R2=0.6%) and full-service restaurant density was positively associated with CVD mortality (β=0.19, R2=0.1%) and negatively related to T2D prevalence (β=-0.25, R2=0.3%). In a multiple regression analysis (FFRs and full-service restaurants together in same model), only the densities of FFRs were significant (and positive). If we assume these relationships are causal, an impact analysis suggested that opening 10 new FFRs in a county would lead to 1 extra death from CVD every 42 years and 1 extra death from stroke every 55 years. Repeated nationally across all counties, that would be an extra 748 CVD deaths and 567 stroke deaths (and 390 new cases of T2D) over the next 10 years.CONCLUSIONS: These results suggest that an increased density of FFRs is associated with increased risk of death from CVD and stroke and increased T2D prevalence, but the maximal impact (assuming the correlations reflect causality) of each individual FFR is small.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT03243253.

AB - BACKGROUND: We explored whether higher densities of fast-food restaurants (FFRs) and full-service restaurants are associated with mortality from cardiovascular disease (CVD) and stroke and the prevalence of type 2 diabetes mellitus (T2D) across the mainland United States.METHODS AND RESULTS: In this cross-sectional study county-level data for CVD and stroke mortality, and prevalence of T2D, were combined with per capita densities of FFRs and full-service restaurants and analyzed using regression. Mortality and diabetes mellitus prevalence were corrected for poverty, ethnicity, education, physical inactivity, and smoking. After adjustment, FFR density was positively associated with CVD (β=1.104, R2=2.3%), stroke (β=0.841, R2=1.4%), and T2D (β=0.578, R2=0.6%) and full-service restaurant density was positively associated with CVD mortality (β=0.19, R2=0.1%) and negatively related to T2D prevalence (β=-0.25, R2=0.3%). In a multiple regression analysis (FFRs and full-service restaurants together in same model), only the densities of FFRs were significant (and positive). If we assume these relationships are causal, an impact analysis suggested that opening 10 new FFRs in a county would lead to 1 extra death from CVD every 42 years and 1 extra death from stroke every 55 years. Repeated nationally across all counties, that would be an extra 748 CVD deaths and 567 stroke deaths (and 390 new cases of T2D) over the next 10 years.CONCLUSIONS: These results suggest that an increased density of FFRs is associated with increased risk of death from CVD and stroke and increased T2D prevalence, but the maximal impact (assuming the correlations reflect causality) of each individual FFR is small.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT03243253.

KW - Biomarker

KW - End-stage renal disease

KW - major adverse cardiac event

KW - mortality

KW - risk stratification

U2 - 10.1161/JAHA.117.007651

DO - 10.1161/JAHA.117.007651

M3 - Article

VL - 7

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 11

M1 - 007651

ER -