A cross-sectional and longitudinal study of neighbourhood disadvantage and cardiovascular disease and the mediating role of physical activity
Introduction
Cardiovascular disease (CVD) is one of the main causes of the death and disease burden in Australia (Health TDo, 2018). In 2014–15, approximately 4.2 million Australian adults (18.3%) reported having a disease of the circulatory system, and this included around 1.2 million people with cardiovascular conditions such as heart disease and stroke. Also, nearly 2.6 million Australians reported having hypertension (high blood pressure) and 430,000 indicated that they had experienced a heart attack at some point in their life (Statistics ABo, 2015).
A number of studies have found that individual indicators of socioeconomic position (SEP) often measured via educational attainment (Correa-Burrows et al., 2019), occupational class (Leyland, 2005) and household income (Sundquist et al., 2004) are associated with cardiovascular morbidity and mortality (Rachele et al., 2016a). In addition to individual-level measures of SEP as risk factors for CVD (Diez Roux et al., 2004), increased attention is now being given to the characteristics of neighbourhoods. Measures of socioeconomic disadvantage can be captured at the neighbourhood level using various indices, typically created using census data, and include variables such as education, occupation, and household income (Turrell et al., 2014). Further, neighbourhoods also have built and social environment characteristics that may contribute to observed outcomes (Rachele et al., 2016a). For example, neighbourhoods with greater levels of disadvantage often have higher levels of crime (Burton et al., 2009; Loh et al., 2018), poorer access to health-promoting amenities such as green space and water bodies (Schultz et al., 2017; Foley and Kistemann, 2015), and poorer access to higher quality public transport (Knuiman et al., 2014). This is evidenced by the growing body of research on the role of neighbourhood environments in CVD prevention (Correa-Burrows et al., 2019; Rachele et al., 2016a). It is important however to identify behavioural factors that mediate relationships between the neighbourhood environment and cardio-metabolic risk markers (Chandrabose et al., 2019) and hence increase the incidence of CVD. Physical activity (PA) has been found to be inversely associated with risk of cardiovascular disease (Kraus et al., 2019). Previous cross-sectional research has indicated that the neighbourhood environment is associated with the level of residents' PA (Turrell et al., 2013), and regular participation in PA reduces the risk of CVD (Wilmore and Costill, 2004). However, few studies have examined the longitudinal mediating role of PA in the relationships between neighbourhood disadvantage and CVD. The aims of this study are two-fold: first, to examine the total effect of neighbourhood disadvantage on CVD; and second, to address the limitations of previous research by examining the indirect effects of neighbourhood disadvantage on CVD, mediated through PA at five time-points between 2007 and 2016. It is hypothesized that those living in more disadvantaged neighbourhoods are more likely to have lower levels of PA while reporting one or more heart related diseases or risk factors.
Section snippets
Methods
The HABITAT study received ethical clearance from the Queensland University of Technology Human Research Ethics Committee (Ref. Nos. 3967H & 1,300,000,161).
Results
Table 1 presents the proportion of participants classified as experiencing CVD, and the mean total Met-min of PA, by neighbourhood disadvantage and individual-level SEP, in 2007, 2011, and 2016. The probability of being classified as having CVD was highest among residents of socioeconomically disadvantaged neighbourhoods, the least educated, the retired, and members of lower-income families. Moreover, a similar trend can be seen in the total Met-min of PA; each of the above-mentioned groups
Discussion
This study contributes to the growing evidence that a neighbourhood's socioeconomic environment plays an important role in the incidence of CVD, independent of individual level socioeconomic factors. Adjustment for a range of confounders only partially explained these associations, suggesting that other underlying behavioural pathways may be involved. A review of the literature showed that higher levels of PA are associated with a lower risk of experiencing heart disease (Kraus et al., 2019),
Conclusion
Our study suggests that some characteristics of disadvantaged neighbourhoods are directly and causally associated with the prevalence and incidence of CVD. Moreover, more deprived neighbourhoods appear to cause residents of these environments to be less physically active which contributes to their increased risk of CVD. Improvement to disadvantaged neighbourhoods may be a potential strategy to enhance population health by encouraging more PA. Further studies are recommended to examine specific
Declaration of interests
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgments
The HABITAT study is funded by the National Health and Medical Research Council (NHMRC) (ID 497236, 339718, 1047453).
References (57)
- et al.
Explaining socio-economic status differences in walking for transport: an ecological analysis of individual, social and environmental factors
(2009) - et al.
Prevalence of self-reported diabetes, hypertension and heart disease in individuals seeking state funding in Trinidad and Tobago, West Indies
J. Epidemiol. Glob. Health
(2013) - et al.
Blue space geographies: Enabling health in place
Health Place
(2015) - et al.
Neighbourhood disadvantage and behavioural problems during childhood and the risk of cardiovascular disease risk factors and events from a prospective cohort
Prev. Med. Rep.
(2017) - et al.
Neighbourhood disadvantage and self-reported type 2 diabetes, heart disease and comorbidity: a cross-sectional multilevel study
Ann. Epidemiol.
(2016) - et al.
Associations between physical activity and the neighbourhood social environment: baseline results from the HABITAT multilevel study
Prev. Med.
(2016) - et al.
A longitudinal examination of improved access on park use and physical activity in a low-income and majority African American neighborhood park
Prev. Med.
(2017) - et al.
Neighborhood disadvantage and physical activity: baseline results from the HABITAT multilevel longitudinal study
Ann. Epidemiol.
(2010) - et al.
Neighborhood disadvantage and physical activity: baseline results from the HABITAT multilevel longitudinal study
Ann. Epidemiol.
(2010) - et al.
Can the built environment reduce health inequalities? A study of neighbourhood socioeconomic disadvantage and walking for transport
Health Place
(2013)
Trajectories of physical activity from midlife to old age and associations with subsequent cardiovascular disease and all-cause mortality
J. Epidemiol. Community Health
Missing Data
Social disadvantage and cardiovascular disease: development of an index and analysis of age, sex, and ethnicity effects
Int. J. Epidemiol.
A tutorial on multilevel survival analysis: methods, models and applications
Int. Stat. Rev.
Validity of self-reported cardiovascular disease events in comparison to medical record adjudication and a statewide hospital morbidity database: the AusDiab study
Intern. Med. J.
Prospective and retrospective duration judgments: a meta-analytic review
Cardiovascular, respiratory, and total mortality attributed to PM 2.5 in Mashhad, Iran
Environ. Monit. Assess.
Perceived barriers to physical activity among older Australians
J. Aging Phys. Act.
HABITAT: a longitudinal multilevel study of physical activity change in mid-aged adults
BMC Public Health
Neighborhood walkability and 12-year changes in cardio-metabolic risk: the mediating role of physical activity
Int. J. Behav. Nutr. Phys. Act.
Cardiometabolic health in adolescence and its association with educational outcomes
J. Epidemiol. Community Health
Multilevel mixed effects parametric survival models using adaptive Gauss–Hermite quadrature with application to recurrent events and individual participant data meta-analysis
Stat. Med.
Physical activity and incident chronic diseases: a longitudinal observational study in 16 European countries
Am. J. Prev. Med.
Neighbourhood environments and mortality in an elderly cohort: results from the cardiovascular health study
J. Epidemiol. Community Health
Internet, Phone, Mail, and Mixed-Mode Surveys: The Tailored Design Method
Mixed-Effects Survival Models. Statistical Modelling of Survival Data with Random Effects
Applied Longitudinal Analysis
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