Abstract DP237: Association between the food environment and ischemic stroke risk: A population-based study

Background: A healthy diet is critical for stroke prevention. Dietary patterns can be influenced by the food environment. We evaluated the association between the modified retail food environment index (mRFEI), a measure that reflects the ratio of healthy vs unhealthy food sources in a neighborhood, and stroke incidence in a large population-based study. Methods: The Brain Attack Surveillance in Corpus Christi (BASIC) Project is an ongoing study that identifies all strokes among residents of Nueces County, Texas. All first-ever ischemic strokes from 2000-2023 were geocoded to census tracts by patient home address at the time of stroke. The primary exposure was the mRFEI (range 0-1; higher=healthier), obtained at the census-tract level from the National Neighborhood Data Archive for each year (2000-2023). Population counts and covariate data were obtained from the US Census (2000) and American Community Survey (2009-2023), with linear interpolation from 2001-2008. Stroke incidence rates for each census tract were estimated using Poisson regression, both unadjusted and after adjustment for age, sex, ethnicity, a neighborhood socioeconomic status (nSES) composite score (reflecting aggregate income, wealth, education, and occupation), and a mRFEI*nSES interaction term. Results: There were 6,586 first-ever ischemic strokes in the study region from 2000-2023. Figure 1 displays the mRFEI for each neighborhood. Notably, higher mRFEI (indicating a healthier mix of food sources) was associated with lower nSES (see Table 1). Poisson regression model parameters are shown in Table 2. In the unadjusted model, there was a marginal association between higher mRFEI and greater stroke incidence (β=1.24; 95%CI 0.98, 1.57, p=0.08). After adjustment for covariates, this association was attenuated and not statistically significant (β=1.01, 95%CI 0.85, 1.21, p=0.89). Higher nSES was associated with lower stroke incidence (β=0.95, 95%CI 0.93, 0.97, p