Key points In US neighborhoods, is there an association between cumulative environmental load and cardiovascular health? Findings In this cross-sectional study of 71,659 US census tracts, neighborhoods in the top quartile of environmental burden experienced significantly higher rates of cardiovascular risk factors (hypertension, diabetes, and obesity) and diseases (coronary heart disease and stroke) in compared to those in the bottom quartile. The association between environmental load and cardiovascular health was more pronounced in socially vulnerable neighborhoods. Meaning The findings of an association between neighborhood environmental burden and poorer cardiovascular health, especially in socially vulnerable communities that are also disproportionately exposed to these conditions, indicate that future studies should investigate the impact of addressing environmental hazards on cardiovascular health. |
Importance
Cardiovascular disease is the leading cause of death in the US. However, little is known about the association between cumulative environmental load and cardiovascular health in US neighborhoods.
Aim
To evaluate the association of environmental load at the neighborhood level with the prevalence of risk factors and cardiovascular diseases, in general and by levels of social vulnerability.
Design, environments and participants
This was a national cross-sectional study of 71,659 US census tracts. The Environmental Burden Indices (EBI) and Social Vulnerability from the US Centers for Disease Control and Prevention (CDC) and the Agency for Toxic Substances and Disease Registry was linked to the 2020 CDC PLACES data set. Data was analyzed from March to October 2023.
Exhibitions
The Environmental Burden Index (EBI), a measure of cumulative environmental burden spanning five domains ( air pollution, hazardous or toxic sites, built environment, transportation infrastructure, and water pollution ).
Main results and measures
Neighborhood-level prevalence of cardiovascular risk factors (hypertension, diabetes, and obesity) and cardiovascular diseases (coronary heart disease and stroke).
Results
Across the United States, neighborhoods with the highest environmental burden (top quartile of EBI) were more likely than those with the lowest environmental burden (bottom quartile of EBI) to be urban (16,626 [92.7%] vs. 13 414 [75.4%]), in the Midwest (5,191 [28.9%] vs. 2,782 [15.6%]), have higher median (IQR) social vulnerability scores (0.64 [0. 36-0.85] vs. 0.42 [0.20-0.65]) and have higher proportions of adults in racial or ethnic minority groups (median [IQR], 34% [12-73] vs. 12% [5-30]).
After adjustment, neighborhoods with the highest environmental burden had significantly higher rates of cardiovascular risk factors than those with the lowest burden, including hypertension (mean [SD], 32.83% [7.99] vs. 32.14% [6.99]; adjusted difference, 0.84%; 95% CI, 0.71-0.98), diabetes (mean [SD], 12.19% [4.33] vs. 10.68% [3.27]; adjusted difference, 0.62%; 95% CI, 0.53-0.70) and obesity (mean [SD], 33.57% [7.62] vs 30 .86% [6.15]; adjusted difference, 0.77%; 95% CI, 0.60-0.94).
Similarly, neighborhoods with the highest environmental burden had significantly higher rates of coronary heart disease (mean [SD], 6.66% [2.15] vs. 6.82% [2.41]; adjusted difference, 0 .28%; 95% CI, 0.22-0.33) and stroke. (mean [SD], 3.65% [1.47] vs. 3.31% [1.12]; adjusted difference, 0.19%; 95% CI, 0.15-0.22). The results were consistent after geospatially comparing the neighborhoods with the highest and lowest environmental burden and as a function of other covariates.
Associations between environmental load quartiles and cardiovascular risk factors and disease were most pronounced among socially vulnerable neighborhoods.
Conclusions and relevance In this cross-sectional study of US neighborhoods, cumulative environmental burden was associated with higher rates of cardiovascular risk factors and disease, although absolute differences were small. The strongest associations were observed in socially vulnerable neighborhoods. Whether initiatives addressing poor environmental conditions will improve cardiovascular health requires additional prospective research. |
