Neighborhood infrastructure-related risk factors and non-communicable diseases: a systematic meta-review

Abstract

Background With rapid urbanization, the urban environment, especially the neighborhood environment, has received increasing global attention. However, a comprehensive overview of the association between neighborhood risk factors and human health remains unclear due to the large number of neighborhood risk factor–human health outcome pairs. Method On the basis of a whole year of panel discussions, we first obtained a list of 5 neighborhood domains, containing 33 uniformly defined neighborhood risk factors. We only focused on neighborhood infrastructure-related risk factors with the potential for spatial interventions through urban design tools. Subsequently, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic meta-review of 17 infrastructure-related risk factors of the 33 neighborhood risk factors (e.g., green and blue spaces, proximity to major roads, and proximity to landfills) was conducted using four databases, Web of Science, PubMed, OVID, and Cochrane Library, from January 2000 to May 2021, and corresponding evidence for non-communicable diseases (NCDs) was synthesized. The review quality was assessed according to the A MeaSurement Tool to Assess Systematic Reviews (AMSTAR) standard. Results Thirty-three moderate-and high-quality reviews were included in the analysis. Thirteen major NCD outcomes were found to be associated with neighborhood infrastructure-related risk factors. Green and blue spaces or walkability had protective effects on human health. In contrast, proximity to major roads, industry, and landfills posed serious threats to human health. Inconsistent results were obtained for four neighborhood risk factors: facilities for physical and leisure activities, accessibility to infrastructure providing unhealthy food, proximity to industry, and proximity to major roads. Conclusions This meta-review presents a comprehensive overview of the effects of neighborhood infrastructure-related risk factors on NCDs. Findings on the risk factors with strong evidence can help improve healthy city guidelines and promote urban sustainability. In addition, the unknown or uncertain association between many neighborhood risk factors and certain types of NCDs requires further research.

Neighborhoods and Cardiovascular Health: A Scientific Statement From the American Heart Association

“…26 In contrast, another review found that associations of access to facilities for physical and leisure activities were null or inconsistent for coronary heart disease, stroke, and type 2 diabetes. 28 Systematic reviews have found null associations of the food environment with CVD-related outcomes overall, but some evidence linking the fast-food environment to higher weight and CVD. [27][28][29] Living in neighborhoods with higher levels of air pollution has been linked to poorer endothelial function and adverse cardiovascular outcomes, including hospitalization and mortality.…”

“…26 In contrast, another review found that associations of access to facilities for physical and leisure activities were null or inconsistent for coronary heart disease, stroke, and type 2 diabetes. 28 Systematic reviews have found null associations of the food environment with CVD-related outcomes overall, but some evidence linking the fast-food environment to higher weight and CVD. 27–29…”

“…28 Systematic reviews have found null associations of the food environment with CVD-related outcomes overall, but some evidence linking the fast-food environment to higher weight and CVD. 27–29…”

“…Other systematic reviews have found consistent evidence supporting associations of walkability and greenspace with lower weight, type 2 diabetes, stroke, and CVD. [27][28][29] In a meta-analysis for obesity, significant associations were found for urban sprawl and population density (the concentration of people and businesses within an area) and recreational facilities, but not route attributes (eg, street connectivity) or destinations (eg, proximity to transit stops). 26 In contrast, another review found that associations of access to facilities for physical and leisure activities were null or inconsistent for coronary heart disease, stroke, and type 2 diabetes.…”

“…Other systematic reviews have found consistent evidence supporting associations of walkability and greenspace with lower weight, type 2 diabetes, stroke, and CVD. 27–29…”