A multicomponent method assessing healthy cardiovascular urban environments: The Heart Healthy Hoods Index. (January 2019)

• Record Type: Journal Article
• Authors: Cebrecos, Alba; Escobar, Francisco; Borrell, Luisa N.; Díez, Julia; Gullón, Pedro; Sureda, Xisca; Klein, Olivier; Franco, Manuel
• Is Part Of: Health & place. Volume 55(2019:Jan.)
• Page Start: 111
• Page End: 119
• Publication Date: 2019-01
• Subjects: Built environment -- Cardiovascular diseases -- Health -- Residence characteristics -- Geographic Information System -- Spatial analysis -- Spain; Health -- Social aspects -- Periodicals; Health services accessibility -- Periodicals; Public health -- Periodicals; Political planning -- Periodicals; Social medicine -- Periodicals; Epidemiology -- Periodicals; Health Policy -- Periodicals; Health Services Accessibility -- Periodicals; Public Health -- Periodicals; Public Policy -- Periodicals; Sociology, Medical -- Periodicals; Épidémiologie -- Périodiques; Politique sanitaire -- Périodiques; Santé, Services de -- Accessibilité -- Périodiques; Health services accessibility; Health -- Social aspects; Political planning; Public health; Social medicine; Periodicals; 613
• DOI: 10.1016/j.healthplace.2018.11.010
• Languages: English
• ISSNs: 1353-8292

Abstract

Abstract: Previous studies have examined the built environment mostly focusing on a single exposure construct (e.g. walkability) to examine its association with health outcomes. This study developed a multicomponent Heart Healthy Hoods Index to characterize heart-healthy urban environments and examined its relationship with the prevalence of cardiovascular disease (CVD) in Madrid, Spain. Using spatial methods, we generated two index models (model 0 unweighted and model 1 weighted) using the percentage of deaths for the main behavioral risk factors for CVD (diet, physical activity, alcohol, and tobacco environments). We performed global (Ordinal Least Square) and local (Geographically Weighed Regression) regression analyses to assess the relationship between both index models and CVD prevalence, and to identify the best index model. In the global analysis, both models showed a significant negative relationship with CVD prevalence. In the local analysis, Model 1 removed the spatial autocorrelation of residuals and showed the lowest values for the Akaike information criterion. This study provides evidence of a non-stationary relationship between the heart-healthy urban environment and CVD prevalence. The HHH index may be an effective tool to identify and prioritize geographical areas for CVD prevention. Highlights: We developed a multicomponent HHH index characterizing heart-healthy urban environments. We examined the spatial association between heart-healthy environments and CVD prevalence. We showed a non-stationary relationship between heart-healthy urban environment and CVD prevalence. HHH index may be an effective tool to identify geographical areas for CVD prevention.