European Journal of Epidemiology

, Volume 25, Issue 10, pp 711–719 | Cite as

Association of fast-food restaurant and fruit and vegetable store densities with cardiovascular mortality in a metropolitan population

  • Mark DanielEmail author
  • Catherine Paquet
  • Nathalie Auger
  • Geng Zang
  • Yan Kestens
Cardiovascular disease


Most studies that link neighbourhoods to disease outcomes have represented neighbourhoods as area-level socioeconomic status. Where objective contextual attributes of urban environments have been measured, few studies of food availability have evaluated mortality as an outcome. We sought to estimate associations between the availability of fast-food restaurants (FFR), fruit and vegetable stores (FVS), and cardiovascular mortality in an urban area. Food business data were extracted from a validated commercial database containing all businesses and services in the Montréal Census Metropolitan Area (MCMA). Mortality data (1999–2003) were obtained for the MCMA (3.4 million residents). Directly standardised mortality rates for cardiovascular deaths (n = 30,388) and non-cardiovascular deaths (all causes − cardiovascular deaths) (n = 91,132) and FFR and FVS densities (n/km2) were analysed for 845 census tracts. Generalised additive models and generalised linear models were used to analyse food source–mortality relationships. FVS density was not associated with cardiovascular or non-cardiovascular mortality (relative risk (RR) = 1.02, 95% confidence interval (CI): 0.76, 1.36, and RR = 1.14, 95% CI: 0.87, 1.50, respectively). Higher FFR density was associated with mortality in bivariate and multivariable analyses. Relative risks of death (95% CI) per 10% increase in FFR density were similar for both cardiovascular and non-cardiovascular mortality: 1.39 (1.19, 1.63) and 1.36 (1.18, 1.57), respectively, accounting for socio-demographic covariates. FFR density is associated with cardiovascular mortality but this relationship is no different in magnitude than that for non-cardiovascular mortality. These results together with null associations between FVS density and mortality do not support a major role for food source availability in cardiovascular outcomes.


Epidemiologic measurements Mortality Cardiovascular disease Residence characteristics Urban health Food environments 

List of abbreviations


Confidence interval


Census tract


Cardiovascular disease


Directly standardised mortality rate


Fast-food restaurant


Fruit and vegetable store


International Classification of Diseases


Montréal Census Metropolitan Area


Relative risk


Standard error


Socioeconomic status


Standard Industry Classification



The authors acknowledge the contributions of Karine Léger, Elisabeth Marks and Abdel Majid Mohamed. This work was funded in part by the Fondation du Centre hospitalier de l’Université de Montréal, Canada Foundation for Innovation (grant #201252, MD) and the Canadian Institutes of Health Research through a Canada Research Chair (Population Health) to MD.


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Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Mark Daniel
    • 1
    • 2
    • 3
    Email author
  • Catherine Paquet
    • 1
  • Nathalie Auger
    • 3
    • 4
  • Geng Zang
    • 3
  • Yan Kestens
    • 3
    • 5
  1. 1.Sansom Institute for Health ResearchThe University of South AustraliaAdelaideAustralia
  2. 2.Department of Medicine, St Vincent’s HospitalThe University of MelbourneMelbourneAustralia
  3. 3.Centre de recherche du Centre hospitalier de l’Université de MontréalMontréalCanada
  4. 4.Institut national de santé publique du QuébecMontréalCanada
  5. 5.Secteur environnement urbain et santéDirection de santé publique de MontréalMontréalCanada

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