A National Study of the Association Between Food Environments and County-Level Health Outcomes
A National Study of the Association Between Food Environments and County-Level Health Outcomes
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DOI：
10.1111/j.1748-0361.2011.00378.x
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发表时间：
2011-09-01
影响因子：
4.9
通讯作者：
Dukas, Stephen
中科院分区：
文献类型：
--
作者：
Ahern, Melissa;Brown, Cheryl;Dukas, Stephen
目的：这项全国性的县级研究考察了大都市区和非大都市区食物可获得性和可获得性以及健康结果(死亡率、糖尿病和肥胖率)之间的关系。方法：这是一项利用食物环境地图集和疾控中心数据进行的二级横断面分析。线性回归模型估计了食品可获得性和获取变量(直接面向消费者的农场销售额、人均杂货店、全方位服务餐厅、快餐店和便利店)与健康结果之间的关系。控制因素包括吸烟、种族/民族、性别、年龄、教育、贫困、初级保健可获得性、娱乐设施可获得性以及mobility/distance-from-grocery-store.Findings：非地铁调查结果：调整后死亡率较低与人均更多提供全方位服务的餐厅和杂货店以及更高的人均农业直接销售额相关。调整后的糖尿病发病率较低与快餐店和便利店的人均供应量减少以及人均全方位服务餐厅和杂货店的增加有关。调整后的肥胖率较低与人均提供全方位服务的餐厅和杂货店更多相关。出乎意料的是，肥胖率与人均杂货店呈正相关，与快餐店呈负相关。Metro调查结果：较多的人均全方位服务餐厅、杂货店和直接农产品销售与积极的健康结果相关；快餐店和便利店与负面的健康结果相关。结论：在大都市和非大都市地区，食品获取/可获得环境是健康结果的重要决定因素。未来的研究应该集中在更精细的规范上，以捕捉非城域环境中的可变性。
Purpose: This national, county-level study examines the relationship between food availability and access, and health outcomes (mortality, diabetes, and obesity rates) in both metro and non-metro areas.Methods: This is a secondary, cross-sectional analysis using Food Environment Atlas and CDC data. Linear regression models estimate relationships between food availability and access variables (direct-to-consumer farm sales, per capita grocery stores, full-service restaurants, fast food restaurants, and convenience stores) with health outcomes. Controls include smoking, race/ethnicity, gender, age, education, poverty, primary care availability, recreational facility availability, and mobility/distance-from-grocery-store.Findings: Non-metro findings: Lower adjusted mortality rates were associated with more per capita full-service restaurants and grocery stores, and greater per capita direct farm sales. Lower adjusted diabetes rates were associated with a lower per capita supply of fast food restaurants and convenience stores, and more per capita full-service restaurants and grocery stores. Lower adjusted obesity rates were associated with more per capita full-service restaurants and grocery stores. Unexpectedly, obesity rates were positively associated with per capita grocery stores and negatively associated with fast food restaurants. Metro findings: More per capita full-service restaurants, grocery stores, and direct farm sales are associated with positive health outcomes; fast food restaurants and convenience stores are associated with negative health outcomes.Conclusions: The food access/availability environment is an important determinant of health outcomes in metro and non-metro areas. Future research should focus on more refined specifications that capture variability across nonmetro settings.