Area Deprivation and the Food Environment Over Time: A Repeated Cross‐Sectional Study on Fast Food Outlet Density and Supermarket Presence in Norfolk, UK, 1990‐2008

Abstract

Little is known about socioeconomic disparities in UK food environments, including how these may have changed over time, limiting our understanding of current diet and health inequalities. We examined fast food outlet density and supermarket presence by area-level deprivation in the county of Norfolk, UK, 1990-2008. Data on food outlet locations, collected from Yellow Pages telephone directories at six time points from 1990 to 2008, were geocoded and mapped onto 2001 electoral ward boundaries. Wards were assigned to deprivation tertiles using the 2001 Townsend Index. Differences in fast food outlet density by deprivation and over time were compared using a one-way repeated measures analysis of variance. Supermarket presence by deprivation over time was examined with a multiple logistic regression model. All models adjusted for ward population. The odds of supermarket presence were not associated with area deprivation over time (tertile 2 vs 1, p=0.82; tertile 3 vs 1, p=0.58). Mean fast food outlet density increased significantly in all deprivation tertiles (p<0.001). However, fast food outlet density was consistently higher in the most deprived areas (p<0.001) and there was a significant interaction between deprivation and time (p=0.095). Results indicate that the most deprived wards faced the highest density of fast food outlets and were subject to the greatest increase in the number of these outlets over time. These increasing socioeconomic disparities in fast food access may be contributing to social inequalities in diet and health in the UK. Supported by UK Clinical Research Collaboration grant MR/K023187/1