Association between Perceived Built Environment and Prevalent Hypertension among South African Adults

Abstract

Introduction. The association between perceived built environmental attributes and hypertension among adults has received little attention in an African context. We investigated the association between the perceived built environment and prevalent hypertension in adult South Africans. Method. A cross-sectional study was conducted using [2008][2009] Prospective Urban Rural Epidemiology data among South African ( = 671) adults aged ≥35 years. Perceived built environment was assessed using the neighborhood environment walkability scale questionnaire. Prevalent hypertension was defined as previously diagnosed by a physician, screen-detected hypertension as ≥140/90 mmHg, and a combination of both as any hypertension. Logistic regressions were applied for analyses. Results. In crude logistic regressions, self-reported hypertension was associated with land use mixdiversity, street connectivity, infrastructure for walking/cycling, aesthetics, traffic, and crime. In adjusted model, land use mixdiversity was significantly associated with self-reported hypertension. In similar multivariable models, the direction and magnitude of the effects were mostly similar to the outcomes of "screen-detected hypertension" which was further predicted by perceived lack of safety from traffic. Conclusion. Perceived built environment attributes were significantly associated with hypertension. This has relevance to population-based approaches to hypertension prevention and control.

Percepção das desordens de bairro e pressão arterial em adultos: um estudo multinível de base populacional

“…Studies have also mentioned the potential protective effect of an environment that favors access to proper resources for physical activity. Malambo et al 5 , in a study with 671 adults in South Africa, observed that the likelihood of hypertension was significantly lower in persons that perceived the neighborhood infrastructure as favorable for walking and cycling (OR = 0.65; 95%CI: 0.46; 0.90). Likewise, Li et al 12 found lower SBP and DBP in residents of neighborhoods with favorable conditions for walking.…”

“…Associated nutritional factors include high sodium and alcohol intake and excess body weight 2,3,4 . Recent studies have also shown that altered blood pressure levels may be related to other factors not exclusively at the individual level, such as contextual or environmental characteristics, including their perception about social and physical disorder in the neighborhood 5,6 .…”

“…Previous studies have shown an association between lack of safety in neighborhoods and high blood pressure. Malambo et al 5 conducted a cross-sectional study of 671 South African adults over 35 years of age and found that those who perceived their neighborhood as exposed to crime showed higher odds of hypertension (OR = 1.44; 95%CI: 1.03; 2.02). A study by Kaiser et al 9 with 3,382 adults 45-84 years of age in six different locations in the United States and covering ten years (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011) found that those who developed hypertension lived in areas that were less favorable to physical activity and with lower presence of healthy foods.…”

“…Beyond government policies and measures to deal with hypertension, the scientific literature is still incipient on the relationship between neighborhood disorder and hypertension 5,9,12 . A major limitation is that most studies consulted in the literature were conducted in high-income countries, and the results may differ from those in middle and low-income countries due to the diverse contextual characteristics.…”

The relationship between objectively-measured attributes of the built environment and selected cardiovascular risk factors in a South African urban setting

“…For example, in a subjective assessment of neighborhood environment, attributes such as proximity to local stores, transit stops, four-way intersections, sidewalks, shade from trees, pleasant scenery, high traffic volume, crosswalks and well-lit streets were significantly associated with physical activity [ 35 ]. In a similar study, land use mix-diversity and safety from traffic was associated with hypertension [ 36 ]. Another study consistently found that built environment attributes were associated with obesity [ 37 ].…”