Retail Environment and Cardiovascular Disease

Family shopping for vegetables in grocery store

Summary

The Retail Environment and Cardiovascular Disease (RECVD) study assessed how changes to access to healthy food sources, medical facilities, and physical activity venues relate to cardiovascular disease, cognitive decline, and subsequent residential relocation of older adults in the U.S., with a focus on addressing health disparities. In 2022, NIA funded the RECVD renewal to examine how recent neighborhood change relates to opportunities to be physically and socially active, and concerns about how the neighborhood is changing.

The renewal was designed to address the following aims: 1) identify aspects of objectively measured neighborhood change (e.g., retail growth or instability, urbanization, gentrification) associated with concerns expressed by residents about neighborhood change; 2) evaluate whether past neighborhood and retail changes likely to be perceived as intense or concerning are associated with subsequent increased depressive symptoms, perceived stress, or relocation; and 3) examine community priorities and values relevant to neighborhood change, informing retail space use and other planning initiatives to address health and well-being needs while limiting harms.

In pursuing the original and renewal aims, we have developed over 60 peer-reviewed manuscripts and contributed to work presented at over 25 conferences to disseminate our methodology and findings. We have invested in developing partnerships, including with an advisory committee with representation across multiple sectors and disciplines beyond academic public health. Our scientific collaboration and contribution to training can be seen in the network of 166 students, faculty, and staff spanning 24 institutions who have worked with our team and the datasets we created. Our findings highlight avenues for community-led articulation of desired neighborhood change and potential policy strategies to leverage built environment change to maximize benefits to population health, healthy aging, and addressing related racial health inequities.

Partners:

The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study at University of Alabama Birmingham; the Collaborative Health Studies Coordinating Center at the University of Washington; the Built Environment and Health Research Group at Columbia University; the Center for Studies in Demography & Ecology at the University of Washington; the New York Academy of Medicine; New York City Department of Mental Health and Hygiene; Rutgers Cancer Institute of New Jersey; the Diabetes Lead Network; the Environment and Policy Laboratory at the University of Michigan, and the Johns Hopkins Center on Aging & Health.

Research Methods

The Retail Environment and Cardiovascular Disease (RECVD) study curated longitudinal geographic data to quantify disparities in access and predict health and aging outcomes. Our assembled decades of retail, land cover, and social environment data has been used to characterize 72,246 census tracts and 32,170 ZIP code tabulation areas throughout the contiguous US, in addition to 1-km and 5-km radial buffers around 55,309 addresses for participants in two ongoing complementary population-based health studies of adults: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, and Cardiovascular Health Study (CHS). Both studies recruited and followed up with socioeconomically diverse populations. The 30,183 REGARDS participants were enrolled from a broad geographic region (48 contiguous U.S. states) in 2003-2007. CHS is a study of 5,888 older adults enrolled in 1990-1993 from four U.S. sites.

In 2023-2024, the RECVD study collected questionnaire data on neighborhood change perceptions and concerns among 7,026 REGARDS participants using questions from a tool called Perceptions About Change in Environment and Residents (PACER). These data have been linked to longitudinal neighborhood characteristics (retail, land use, sociodemographic), and individual health-relevant data.

Interpretation of this work will be informed by an external advisory committee, building a foundation for future intervention planning and public deliberation events to foster participatory neighborhood change that benefits health.

A resource was developed and launched in early 2023 on neighborhood food environment measurement options. Compiling and annually updating this information can make visible what we have learned, so that different teams do not each have to start from scratch in exploring and selecting among the available data sources. Development is underway for a similar resource relevant to spatial social polarization.

Research Results

Contributions of this growing body of literature include timely policy-relevant work and use or adaptation of our retail data methods to add value to other research data. Recent examples include:

Hernandez MA, Hirsch JA, Mucciaccio FA, Kumar A, Tabb LP, Finlay JM, Bader MD, Bennett A, Michael YL, Lovasi GS. Gentrification and Fear of Displacement: A Quantitative Study of Older Black and White US Adults. Journal of racial and ethnic health disparities. 2025 Nov 11:1-3.

Moored KD, Desjardins MR, Crane BM, Donahue PT, Richards EA, Hirsch JA, Lovasi GS, Rosso AL, Garg PK, Shields TM, Curriero FC. Neighborhood Physical Activity Facilities Predict Risk of Incident Mixed and Vascular Dementia: The Cardiovascular Health Cognition Study. Alzheimer's & dementia. 2025 Jan;21(1):e14387.

Bhatia R, Hernandez MA, Platt J, Newman AB, Siscovick DS, Mukamal KJ, Lovasi GS. Associations of Neighbourhood Food Retail with Disability and Death in Older Adults: Cardiovascular Health Study. BMJ nutrition, prevention & health. 2024 Dec 8;7(2):e000646.

Hirsch JA, Zhao Y, Melly S, Moore KA, Berger N, Quinn J, Rundle A, Lovasi GS. National trends and disparities in retail food environments in the USA between 1990 and 2014. Public Health Nutr. 2023 May;26(5):1052-1062.

Godina SL, Rosso AL, Hirsch JA, Besser LM, Lovasi GS, Donovan GH, Garg PK, Platt JM, Fitzpatrick AL, Lopez OL, Carlson MC, Michael YL. Neighborhood greenspace and cognition: The cardiovascular health study. Health Place. 2023 Jan;79:102960.

Zhang K, Lovasi GS, Odden MC, Michael YL, Newman AB, Arnold AM, Kim DH, Wu C. Association of Retail Environment and Neighborhood Socioeconomic Status With Mortality Among Community-Dwelling Older Adults in the United States: Cardiovascular Health Study. J Gerontol A Biol Sci Med Sci. 2022 Nov 21;77(11):2240-2247.

View a full list of publications

Acknowledgements

Thank you to the participants of REGARDS and CHS for their participation in the parent studies and helping scientists understand how to prevent chronic disease.

Research Team

This work was supported by the National Institute of Aging (grants R01AG049970, R01AG049970-S1, R01AG072634, R56AG049970), National Heart, Blood, and Lung Institute (grant R01HL14843), National Institute on Alcohol Abuse and Alcoholism (R01AA028552), Commonwealth Universal Research Enhancement (C.U.R.E) program funded by the Pennsylvania Department of Health - 2015 Formula award - SAP #4100072543, the Urban Health Collaborative at Drexel University, the Built Environment and Health Research Group at Columbia University, Columbia University Robert N Butler Center for Aging, and a generous gift from Dana and David Dornsife to the Drexel University Dornsife School of Public Health.

The Food Environment Database Directory was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number 1UB6HP31689‐01‐00 “Public Health Training Centers”. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.