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Retail Environment and Cardiovascular Disease

Evaluating how access to healthy food sources, physical activity and medical facilities affect racial disparities in cardiovascular disease.

Senior shopping for vegetables in grocery store


The Retail Environment and Cardiovascular Disease (RECVD) project assessed how changes to access of healthy food sources, medical facilities, and physical activity venues relate to cardiovascular disease (CVD) and cognitive decline and subsequent residential relocation of older adults in the U.S, with a focus on addressing health disparities. The overarching goal was to generate and disseminate actionable knowledge on the role of the local neighborhood contexts to inform strategies for tailoring local action to reduce health disparities and support aging-in-place.

RECVD used individual health-relevant data from the two complementary population-based cohort 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. 


Reasons for Geographic and Racial Differences in Stroke (REGARDS) Project at University of Alabama Birmingham; Built Environment and Health Research Group at Columbia UniversityColumbia University Population Research CenterThe Collaborative Health Studies Coordinating Center (CHSCC) at University of Washington; Urban Form Lab (UFL) at University of Washington;  New York Academy of MedicineEnvironment and Policy Laboratory in the School of Kinesiology at University of Michigan; Multi-Ethnic Study of Atherosclerosis (MESA) at Department of Epidemiology, School of Public Health at University of Michigan; Diabetes Lead Network; and Loni Tabb PhD, Department of Epidemiology and Biostatistics, Dornsife School of Public Health at Drexel University; Andrea Rosso, PhD, MPH, Brain, Environment, Aging, and Mobility (BEAM) lab at University of Pittsburgh.

Research Methods

We curated national longitudinal geographic datasets, which included sociodemographic, land cover, rail transit and retail data for the 25-year period from 1990 through 2014 of

  • 72,246 census tracts throughout the continental US
  • 32,170 ZIP code tabulation areas (ZCTA) throughout the continental US
  • 13,790 1-km and 13,790 5-km radial buffers centered on home addresses of participants from the Cardiovascular Health Study (CHS)
  • 41,515 1-km and 41,515 5-km radial buffers centered on the home addresses of participants from the Reasons for Geographic And Racial Differences in Stroke (REGARDS)

We finalized documentation and sharing plans for the datasets. In addition, based on the rigor and transparency of our methods, we have been invited to collaborate with several federally funded research projects including work with


1) the Census Headquarters staff to the NIH funded Mortality Disparities in American Communities data 

2) others who have grant funding to characterize the geographic contexts surrounding REGARDS or CHS participants [Natalie Colabianchi (Environment and Policy Lab, University of Michigan)]

3) with the CDC-funded Diabetes LEAD Network assess the food environment, physical activity, and medical facilities in residential neighborhoods.

We continue to collaborate and publish papers.

Research Results

The following papers have been published: 


Kaufman, T.K., Rundle, A., Neckerman, K.M., Sheehan, D.M., Lovasi, G.S. and Hirsch, J.A., 2019. Neighborhood recreation facilities and facility membership are jointly associated with objectively measured physical activity. Journal of Urban Health96(4), pp.570-582.


Rundle, A.G., Chen, Y., Quinn, J.W., Rahai, N., Bartley, K., Mooney, S.J., Bader, M.D., Zeleniuch-Jacquotte, A., Lovasi, G.S. and Neckerman, K.M., 2019. Development of a neighborhood walkability index for studying neighborhood physical activity contexts in communities across the US over the past three decades. Journal of Urban Health96(4), pp.583-590.


Berger, N., Kaufman, T.K., Bader, M.D., Rundle, A.G., Mooney, S.J., Neckerman, K.M. and Lovasi, G.S., 2019. Disparities in trajectories of changes in the unhealthy food environment in New York City: A latent class growth analysis, 1990–2010. Social Science & Medicine234, p.112362.


Hirsch JA, Zhao Y, Bilal U, Neckerman KM, Michael YL. Health and Health-Related Resources in Newly Designated Federally Qualified Opportunity Zones: United States, 2012-2016. American Journal of Public Health. 2020 Mar;110(3):407-415.


Tsui J, Hirsch JA, Bayer FJ, Quinn JW, Cahill J, Siscovick D, Lovasi GS. Patterns in Geographic Access to Health Care Facilities Across Neighborhoods in the United States Based on Data from the National Establishment Time-Series Between 2000 and 2014. JAMA Network Open. 2020 May 1;3(5):e205105.


Hirsch, J.A., Moore, K.A., Cahill, J., Quinn, J., Zhao, Y., Bayer, F.J., Rundle, A. and Lovasi, G.S., 2020. Business Data Categorization and Refinement for Application in Longitudinal Neighborhood Health Research: a Methodology. Journal of Urban Health, Oct 1, pp.1-14. 


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. We wish to thank postdoctoral fellows Allana Forde, PhD, MPH, and Pedro Gullón Tosio, MD, PhD.

Research Team


This work was supported by the National Institute of Aging (grants 1R01AG049970, 3R01AG049970-04S1), 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.