Cross-sectional associations between residential environmental exposures and cardiovascular diseases.
BACKGROUND
Prior research examining neighbourhood effects on cardiovascular diseases (CVDs) has focused on the impact of neighbourhood socio-economic status or a few selected environmental variables. No studies of cardiovascular disease outcomes have investigated a broad range of urban planning related environmental factors. This is the first study to combine multiple neighbourhood influences in an integrated approach to understanding the association between the built and social environment and CVDs. By modeling multiple neighbourhood level social and environmental variables simultaneously, the study improved the estimation of effects by accounting for potential contextual confounders.


METHODS
Data were collected using a cross-sectional survey (n = 2411) across 87 census tracts (CT) in Toronto, Canada, and commercial and census data were accessed to characterize the residential environment. Multilevel regressions were used to estimate the associations of neighbourhood factors on the risk of CVD.


RESULTS
Exposure to violent crimes, environmental noise, and proximity to a major road were independently associated with increased odds of CVDs (p < 0.05) in the fully adjusted model. While reduced access to food stores, parks/recreation, and increased access to fast food restaurants were associated with increased odds of CVDs in partially adjusted models (p < 0.05), these associations were fully attenuated after adjusting for BMI and physical activity. Housing disrepair was not associated with CVD risk.


CONCLUSIONS
These findings illustrate the importance of measuring and modeling a broad range of neighborhood factors--exposure to violent crimes, environmental noise, and traffic, and access to food stores, fast food, parks/recreation areas--to identify specific stressors in relation to adverse health outcomes. Further research to investigate the temporal order of events is needed to better understand the direction of causation for the observed associations.
Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK. antony.chum@lshtm.ac.uk.|Centre for Research on Inner City Health, St. Michael's Hospital, 209 Victoria, 3rd floor, Toronto, ON, M5B 1C6, Canada. antony.chum@lshtm.ac.uk.
Antony
A
Chum
Centre for Research on Inner City Health, St. Michael's Hospital, 209 Victoria, 3rd floor, Toronto, ON, M5B 1C6, Canada. OCampoP@smh.ca.
Patricia
P
O'Campo
D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D004781:Environmental Exposure / Q000706:statistics & numerical data*; D057140:Fast Foods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012147:Restaurants; D012923:Social Class; D012931:Social Environment; D014504:Urban Health / Q000706:statistics & numerical data*