Environmental factors and cardiovascular diseases: the association of income inequality and green spaces in elderly residents of São Paulo, Brazil.
We aimed to analyse the individual and contextual determinants associated with cardiovascular diseases (CVDs) morbidity among the elderly.



The sample consisted of 1333 individuals aged 60 or older residing in the city of São Paulo, from the Health, Welfare and Aging (SABE) study survey performed in 2010. The association between CVD with both income inequality and green spaces was analysed using Bayesian multilevel models, controlling for individual and contextual factors.



We found a significant association between income inequality and green spaces, and risk of CVD. In comparison to elderly residents in areas with low-income inequality, there was an increased risk for CVD among those residing in the medium-low (OR=1.35, 95% CI 1.15 to 1.59), medium-high (OR=2.71, 95% CI 2.18 to 3.36) and high (OR=1.43, 95% CI 1.14 to 1.79) quartiles of income inequality. Those living in medium-low (OR=0.44, 95% CI 0.39 to 0.49), medium-high (OR=0.56, 95% CI 0.48 to 0.65) and high (OR=0.48, 95% CI 0.43 to 0.55) green spaces levels had lower risk of CVD.



These findings highlight the importance of area-level characteristics on CVD risk and the need to develop healthcare policies focused on the effect of individual and contextual characteristics.
Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil.
Kaio Henrique Correa
KH
Massa
Department of Community Health Sciences, University of Nevada, Reno, Nevada, USA.
Roman
R
Pabayo
Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil.
Maria Lúcia
ML
Lebrão
Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil.
Alexandre Dias Porto
AD
Chiavegatto Filho
D000368:Aged; D000369:Aged, 80 and over; D001499:Bayes Theorem; D001938:Brazil / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D004779:Environment Design; D005260:Female; D006304:Health Status; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D055361:Multilevel Analysis; D011998:Recreation; D012111:Residence Characteristics; D012307:Risk Factors; D011795:Surveys and Questionnaires
Cardiovascular disease; Elderly; Multilevel modelling; Social inequalities