Abstract
Rationale & Objective: Living in environments with low access to food may increase the risk of chronic diseases. We investigated the association of household distance to the nearest supermarket (as a measure of food access) with the incidence of hypertension, diabetes, and chronic kidney disease (CKD) in a metropolitan area of the United States. Study Design: Retrospective cohort study. Setting & Participants: 777,994 individuals without hypertension, diabetes, or CKD at baseline within the HealthLNK Data Repository, which contains electronic health records from 7 health care institutions in Chicago, Illinois. Exposure: Zip code–level average distance between households and nearest supermarket. Outcome: Incidence of hypertension, diabetes, and CKD based on presence of ICD-9 code and/or blood pressure ≥ 140/90 mm Hg, hemoglobin A1c ≥ 6.5%, and eGFR < 60 mL/min/1.73m2, respectively. Analytical Approach: Average distance to nearest supermarket was aggregated from street-level metrics for 56 Chicagoland zip codes. The cumulative incidence of hypertension, diabetes, and CKD from 2007-2012 was calculated for each zip code in patients free of these diseases in 2006. Spatial analysis of food access and disease incidence was performed using bivariate local indicator of spatial association (BiLISA) maps and bivariate local Moran I statistics. The relationship between supermarket access and outcomes was analyzed using logistic regression. Results: Of 777,994 participants, 408,608 developed hypertension, 51,380 developed diabetes, and 56,365 developed CKD. There was significant spatial overlap between average distance to supermarket and incidence of hypertension and diabetes but not CKD. Zip codes with large average supermarket distances and high incidence of hypertension and diabetes were clustered in southern and western neighborhoods. Models adjusted only for neighborhood factors (zip code–level racial composition, access to vehicles, median income) revealed significant associations between zip code–level average distance to supermarket and chronic disease incidence. Relative to tertile 1 (shortest distance), ORs in tertiles 2 and 3, respectively, were 1.27 (95% CI, 1.23-1.30) and 1.38 (95% CI, 1.33-1.43) for diabetes, 1.03 (95% CI, 1.02-1.05) and 1.04 (95% CI, 1.02-1.06) for hypertension, and 1.18 (95% CI, 1.15-1.21) and 1.33 (95% CI, 1.29-1.37) for CKD. Models adjusted for demographic factors and health insurance showed significant and positive association with greater odds of incident diabetes (tertile 2: 1.29 [95% CI, 1.26-1.33]; tertile 3: 1.35 [95% CI, 1.31-1.39]) but lesser odds of hypertension (tertile 2: 0.95 [95% CI, 0.94-0.97]; tertile 3: 0.91 [95% CI, 0.89-0.92]) and CKD (tertile 2: 0.80 [95% CI, 0.78-0.82]; tertile 3: 0.73 [95% CI, 0.72-0.76]). After adjusting for both neighborhood and individual covariates, supermarket distance remained significantly associated with greater odds of diabetes and lesser odds of hypertension, but there was no significant association with CKD. Limitations: Unmeasured neighborhood and social confounding variables, zip code–level analysis, and limited individual-level information. Conclusions: There are significant disparities in supermarket proximity and incidence of hypertension, diabetes, and CKD in Chicago, Illinois. The relationship between supermarket access and chronic disease is largely explained by individual- and neighborhood-level factors.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 168-178 |
| Number of pages | 11 |
| Journal | American Journal of Kidney Diseases |
| Volume | 81 |
| Issue number | 2 |
| DOIs | |
| State | Published - Feb 2023 |
Funding
Gaurang Garg, MD, Yacob G. Tedla, PhD, Anika S. Ghosh, MS, Dinushika Mohottige, MD, MPH, Marynia Kolak, PhD, Myles Wolf, MD, MMSc, and Abel Kho, MD. Research idea and study design: GG, YGT, MK, MW, AK; data acquisition: GG, ASG, YGT, MK, MW, AK; data analysis/interpretation: GG, ASG, YGT, DM, MK, MW, AK; statistical analysis: GG, ASG, YGT, MK; supervision and mentorship: MW, AK. Each author contributed important intellectual content during manuscript drafting or revision and agrees to be personally accountable for the individual's own contributions and to ensure that questions pertaining to the accuracy or integrity of any portion of the work, even one in which the author was not directly involved, are appropriately investigated and resolved, including with documentation in the literature if appropriate. Dr Wolf is supported by AHA Strategically Focused Research Network Center in Health Disparities grant. The supporters had no role in study design, data collection, analysis, reporting, or the decision to submit for publication. The authors declare that they have no relevant financial interests. We thank the Institute for Public Health and Medicine at Northwestern University, Feinberg School of Medicine, for assistance in background research; Zahra Hosseinian and the HDR team for assistance with data acquisition; and Daniel R. Block, PhD, at the Chicago State University for previous data and guidance. Received May 7, 2020. Evaluated by 2 external peer reviewers and a statistician, with direct editorial input from an Associate Editor and a Deputy Editor who served as Acting Editor-in-Chief. Accepted in revised form July 15, 2022. The involvement of an Acting Editor-in-Chief was to comply with AJKD's procedures for potential conflicts of interest for editors, described in the Information for Authors & Journal Policies. Dr Wolf is supported by AHA Strategically Focused Research Network Center in Health Disparities grant. The supporters had no role in study design, data collection, analysis, reporting, or the decision to submit for publication.
Keywords
- Chronic disease
- chronic kidney disease (CKD)
- diabetes
- dietary pattern
- electronic health record (EHR)
- food access
- food desert
- health disparities
- hypertension
- kidney function
- modifiable risk factor
- neighborhood
- neighborhood deprivation
- nutrition
ASJC Scopus subject areas
- Nephrology
