The Relationship between the Supply of Fast-Food Chains and Cardiovascular Outcomes
Alter, David A., Eny, Karen, Canadian Journal of Public Health
Objective: To examine the extent to which inter-regional differences in fast-food concentrations account for variations in all-cause mortality and acute coronary syndromes throughout Ontario, Canada.
Methods: Nine distinct fast-food chains were selected based on top sales data in 2001. The per capita rate of fast-food outlets per region was calculated for each of 380 regions throughout Ontario. Outcome measures, obtained using 2001 vital statistics data and hospital discharge abstracts, included regional per capita mortality rates and acute coronary syndrome hospitalization rates; head trauma served as a comparator. All regional outcomes were adjusted for age, gender, and socio-economic status, and were analyzed as continuous and rank-ordered variables as compared with the provincial average.
Results: Mortality and admissions for acute coronary syndromes were higher in regions with greater numbers of fast-food services after adjustment for risk. Risk-adjusted outcomes among regions intensive in fast-food services were more likely to be high outliers for both mortality (Adjusted Odds Ratio (OR): 2.52, 95% confidence intervals (CI): 1.54-4.13, p<0.001) and acute coronary hospitalizations (Adjusted OR: 2.62, 95% CI 1.42-3.59, p<0.001) compared to regions with low fast-food service intensity. There was no relationship between the concentration of fast-food outlets and risk-adjusted head-trauma hospitalization rates.
Interpretation: Inter-regional cardiac outcome disparities throughout Ontario were partially explained by fast-food service intensity. Such findings emphasize the need to target health promotion and prevention initiatives to highest-risk communities.
MeSH terms: Coronary disease; human; risk; food supply; restaurants; mortality
Cardiovascular disease is the leading cause of death in North America.1,2 Available evidence has demonstrated marked inter-regional variations in cardiovascular mortality in Canada, and worldwide.3-6 The positive correlation between the prevalence of atherogenic risk factors and mortality have led many to hypothesize that inter-regional mortality variations may be attributable in part to differences in patient lifestyle behaviours, physician prevention and counseling initiatives, and/or government-supported health promotion activities across communities.7-10
The fast-food industry generates $5.1 billion in sales per year,11 and accounts for nearly 4.7% annual Gross Domestic Product of "Specified Expenditures as a Share of Personal Disposable Income in Ontario."12 Over the past four decades, increasing service demands have led to an exponential growth in the supply of fast-food restaurants throughout the country.13-15 While population health surveys have demonstrated the presence of lower body-mass indexes (BMI) and healthier nutritional food consumption among communities with improved cardiovascular health and outcomes,16-18 no study has specifically examined the relationship between mortality variations and fast-food supply in Canada, or elsewhere. Moreover, given the positive correlation between socio-economic status, health status, and survival,19,20 one may hypothesize that the impact of the fast-food industry may affect outcomes differently in lower as compared to higher socio-economic communities.
The objective of this study was to examine the extent to which inter-regional differences in fast-food concentrations accounted for variations in all-cause mortality and acute coronary syndromes, and to examine the interaction among socio-economic status, fast-food intensity and outcomes throughout Ontario, Canada.
We identified nine leading fast-food chains based on market shares, total sales, and data availability.21 They included: McDonalds©, KFC©, Taco Bell©, Wendy's©, Harvey's©, Swiss Chalet©, Dairy Queen©, Pizza Hut©, and Burger King©. For each fast-food chain, we abstracted postal codes to identify the geographical region of each outlet using 2001 electronic public access files (Canada 411(TM) and Canada Post(TM)). …