Food Swamps And Their Impact On Raising Stroke Risk

Janet Tiberian Author
By Janet Tiberian, MA, MPH, CHES
February 17, 2023
Someone grabbing a soda from a convenience store

Have you ever heard of a “food swamp”? Researchers coined the term in 2009 to describe a typically low income community, that’s fraught with:

  • Fast food restaurants
  • Gas stations
  • Donut shops
  • Convenience marts
  • Package stores

 They often emerge in regions deemed as food desserts, i.e., areas that lack the availability of healthy food choices. 

As you would guess – food swamps are problematic. They’re strongly linked to poor dietary habits and obesity, raising the risk for type 2 diabetes, metabolic syndrome and heart disease. They also raise the risk for stroke among adults ages 50 and older who live nearby compared to adults living in areas with healthier food choices, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2023. 

“Some municipalities have set up zoning and permitting laws to help foster a healthier food environment and help offset the public health issues associated with food swamps, such as stroke, but a lot more work needs to be done” says Bernard Kaminetsky, MD, medical director, MDVIP. “Despite years of research, treatments and interventions, stroke is still a leading cause of death both in the U.S. and worldwide. Like heart attacks, good nutrition can help prevent strokes; however, most people need an environment conducive to a healthy lifestyle.”

Columbia University Medical Center researchers were interested in seeing if there was a connection between food swamps and strokes. They based their study on data collected between 2010 and 2016 from University of Michigan’s ongoing Health and Retirement study (or HRS). HRS surveyed middle-aged and older Americans on the challenges and opportunities associated with aging and retirement. HRS cross-referenced data with food environment information from the U.S. Department of Agriculture to develop a retail food environment index (RFEI), providing a ratio of fast-food restaurants and convenience stores to the number of retail healthy food options within neighborhoods.

Columbia researchers reanalyzed survey responses from 17,875 adults recruited from all over the U.S. (average age was 64; 54 percent were women and 84 percent were white). They expanded on the RFEI to include more unhealthy food options such as convenience stores, fast-food restaurants, full-service restaurants, as well as healthy options like grocery stores, farmers’ markets and specialized food stores. Statistical weighting was applied to adjust the data so that it represented the 84-million, community-dwelling, stroke-free adults living in the U.S. 

The expanded RFEI ratios were divided into two groups – less than 5 or 5 or more. Previous studies found that a ratio of 5 or higher may predict a community’s obesity prevalence. Results from the analysis showed:

  • The median RFEI ratio across all communities was 6. This means many participants lived in communities that had six times as many unhealthy food options as healthy food options. 
  • 28 percent of people were living in areas in which the RFEI ratio was below 5.
  • 72 percent of people were living in areas in which the RFEI ratio was 5 or higher. 

People living in an area where the ratio was 5 or higher had a 13 percent higher chance of having a stroke than those living in areas with RFEI ratio lower than 5.

“This study was very interesting. It had a couple of drawbacks. For instance, it was observational, so it doesn’t imply a cause and effect. And it was based on a moment in time – 2010 to 2016. However, results do suggest a tie between food swamps and stroke,” says Kaminetsky. “More importantly, everyone -- regardless of where you live -- is inundated with unhealthy food choices. This is why you need to work closely with your primary care doctor. They can educate you on making sound nutritional choices and help keep you accountable.”

Looking for a primary care physician? Consider partnering with an MDVIP-affiliated physician. An MDVIP-affiliated doctor can customize a wellness plan for you that can focus on nutrition. Find an MDVIP affiliate near you and begin your partnership in health »

About the Author
Janet Tiberian Author
Janet Tiberian, MA, MPH, CHES

Janet Tiberian is MDVIP's health educator. She has more than 25 years experience in chronic disease prevention and therapeutic exercise.

View All Posts By Janet Tiberian, MA, MPH, CHES
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