Neighborhood Environmental Burden and Cardiovascular Health in the US

Abstract

ImportanceCardiovascular disease is the leading cause of death in the US. However, little is known about the association between cumulative environmental burden and cardiovascular health across US neighborhoods.ObjectiveTo evaluate the association of neighborhood-level environmental burden with prevalence of cardiovascular risk factors and diseases, overall and by levels of social vulnerability.Design, Settings, and ParticipantsThis was a national cross-sectional study of 71 659 US Census tracts. Environmental burden (EBI) and social vulnerability indices from the US Centers for Disease Control and Prevention (CDC) and Agency for Toxic Substances and Disease Registry were linked to the 2020 CDC PLACES data set. Data were analyzed from March to October 2023.ExposuresThe EBI, a measure of cumulative environmental burden encompassing 5 domains (air pollution, hazardous or toxic sites, built environment, transportation infrastructure, and water pollution).Main Outcomes and MeasuresNeighborhood-level prevalence of cardiovascular risk factors (hypertension, diabetes, and obesity) and cardiovascular diseases (coronary heart disease and stroke).ResultsAcross the US, neighborhoods with the highest environmental burden (top EBI quartile) were more likely than those with the lowest environmental burden (bottom EBI quartile) to be urban (16 626 [92.7%] vs 13 414 [75.4%]), in the Midwest (5191 [28.9%] vs 2782 [15.6%]), have greater 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). Results were consistent after matching highest and lowest environmentally burdened neighborhoods geospatially and based on other covariates. The associations between environmental burden quartiles and cardiovascular risk factors and diseases were most pronounced among socially vulnerable neighborhoods.Conclusions and RelevanceIn this cross-sectional study of US neighborhoods, cumulative environmental burden was associated with higher rates of cardiovascular risk factors and diseases, although absolute differences were small. The strongest associations were observed in socially vulnerable neighborhoods. Whether initiatives that address poor environmental conditions will improve cardiovascular health requires additional prospective investigations.

Community Socioeconomic Status, Acute Cardiovascular Hospitalizations, and Mortality in Medicare, 2003 to 2019

“…[25][26][27] Second, the presence of green space and recreational spaces needed, as well as the availability of healthy foods, is more limited in disadvantaged communities, 25,[28][29][30][31] while exposure to air pollution and other environmental stressors is higher. [32][33][34] In addition, adults living in these communities are more likely to experience poverty, housing instability, job insecurity, and food insecurity, all of which contribute to a higher burden of cardiovascular risk factors and disease. 25,27 Public health and policy efforts that address social determinants of health, as well as the underlying systemic and structural inequities disproportionately borne by disadvantaged communities, are needed to narrow the persistent gap in cardiovascular hospitalizations.…”

Prioritizing the Exposome to Reduce Cardiovascular Disease Burden

“…In this issue, Liu et al investigate the association of environmental burdens with cardiovascular disease at the neighborhood level. They use a newly developed assessment tool from the US Centers for Disease Control and Prevention (CDC) that captures an array of general environmental exposures with the potential to impact entire communities.…”

“…For this analysis, Liu et al summed the index score into quartiles, with the top quartile having the highest burden of environmental exposures. Communities that were more urban, those located in the Northeast or Midwest, and those with higher poverty rates and greater representation of racial and ethnic minority groups were more likely to be in this top quartile.…”

“…The authors additionally assessed the strength of the association between environmental burden and cardiovascular risk factors and disease by a community’s social vulnerability index, which captures measures of socioeconomic and demographic status—a well-known determinant of poor health outcomes . They find that the association between environment and cardiovascular disease is more pronounced in communities with the highest social vulnerability, but again, causal inference is challenging in ecological analyses.…”