Abstract
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
Résmé
Objectif
Examiner la mesure dans laquelle les différences interrégionales dans la concentration des restaurants rapides expliquent les écarts dans la mortalité toutes causes confondues et dans les syndromes coronariens aigus à l’échelle de l’Ontario.
Méthode
Nous avons sélectionné les neuf chaînes de restaurants rapides dont les ventes étaient les plus élevées en 2001, puis calculé le taux de restaurants rapides par habitant pour chacune des 380 régions de l’Ontario. Les résultats, obtenus à partir des statistiques démographiques de 2001 et du registre des sorties des hôpitaux, comprenaient les taux régionaux de mortalité par habitant et les taux d’hospitalisation liés aux syndromes coronariens aigus; les traumatismes crâniens nous ont servi à établir des comparaisons. Nous avons ajusté tous les résultats régionaux selon l’âge, le sexe et le statut socio-économique, et nous les avons analysés selon une échelle continue et ordinale par rapport à la moyenne provinciale.
Résultats
Après ajustement selon le risque, la mortalité et les hospitalisations liées aux syndromes coronariens aigus étaient supérieures dans les régions où l’on trouvait le plus grand nombre de restaurants rapides. Les résultats ajustés selon le risque dans les régions à forte concentration de restaurants rapides étaient plus susceptibles de présenter des valeurs aberrantes élevées, tant pour la mortalité (rapport de cotes ajusté (RC) = 2,52, intervalle de confiance (IC) de 95 % = 1,54-4,13, p≤0,001) que pour les hospitalisations liées aux syndromes coronariens aigus (RC ajusté = 2,62, IC de 95 % = 1,42-3,59, p≤0,001), que dans les régions à faible concentration de restaurants rapides. Nous n’avons constaté aucun lien entre la concentration des restaurants rapides et les taux d’hospitalisation pour traumatismes crâniens ajustés selon le risque.
Interprétation
Les disparités interrégionales dans les résultats cardiaques en Ontario s’expliquent en partie par le niveau de concentration des restaurants rapides, d’où la nécessité d’orienter les initiatives de promotion de la santé et de prévention en fonction des collectivités les plus vulnérables.
Footnotes
Acknowledgements: We express our sincere gratitude to Ms. Wendy Cooke and Ms. Adee Bross for their efforts in helping to abstract locations of fast-food outlets for this study. We also thank Drs. Don Redelmeier and Geoff Anderson for their helpful comments on an earlier version of this manuscript.
Sources of support: Dr. Alter is a New Investigator at the Canadian Institutes of Health Research and is co-funded by the Heart and Stroke Foundation of Canada. Karen Eny (University of Guelph, Undergraduate student majoring in Applied Human Nutrition) was supported by the Heart and Stroke Foundation of Canada’s John D. Schultz Science Student Scholarship.
The Institute for Clinical Evaluative Sciences is supported in part by a grant from the Ontario Ministry of Health. The results, conclusions, and opinions are those of the authors, and no endorsement by the Ministry or the Institute is intended or should be inferred.
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