Association of neighborhood physical activity facilities with incident cardiovascular disease

Yulin Huang; Huimin Zhao; Qiuju Deng; Yue Qi; Jiayi Sun; Miao Wang; Jie Chang; Piaopiao Hu; Yuwei Su; Ying Long; Jing Liu

doi:10.1186/s12942-023-00340-9

Association of neighborhood physical activity facilities with incident cardiovascular disease

Int J Health Geogr. 2023 Jul 29;22(1):16. doi: 10.1186/s12942-023-00340-9.

Authors

Yulin Huang^#^{1

2

3

4

5}, Huimin Zhao^#⁶, Qiuju Deng^{1

2

3

4

5}, Yue Qi^{1

2

3

4

5}, Jiayi Sun^{1

2

3

4

5}, Miao Wang^{1

2

3

4

5}, Jie Chang^{1

2

3

4

5}, Piaopiao Hu^{1

2

3

4

5}, Yuwei Su⁷, Ying Long⁸, Jing Liu^{9

10

11

12

13}

Affiliations

¹ Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, 100029, Beijing, China.
² Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, 100029, China.
³ National Clinical Research Center of Cardiovascular Diseases, 100029, Beijing, China.
⁴ The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, 100029, China.
⁵ The Beijing Municipal Key Laboratory of Clinical Epidemiology, 100029, Beijing, China.
⁶ School of Architecture and Hang Lung Center for Real Estate, Key Laboratory of Eco Planning & Green Building, Ministry of Education, Tsinghua University, Beijing, 100084, China.
⁷ School of Urban Design, Wuhan University, Wuhan, 430072, China.
⁸ School of Architecture and Hang Lung Center for Real Estate, Key Laboratory of Eco Planning & Green Building, Ministry of Education, Tsinghua University, Beijing, 100084, China. ylong@tsinghua.edu.cn.
⁹ Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, 100029, Beijing, China. jingliu@ccmu.edu.cn.
¹⁰ Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, 100029, China. jingliu@ccmu.edu.cn.
¹¹ National Clinical Research Center of Cardiovascular Diseases, 100029, Beijing, China. jingliu@ccmu.edu.cn.
¹² The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, 100029, China. jingliu@ccmu.edu.cn.
¹³ The Beijing Municipal Key Laboratory of Clinical Epidemiology, 100029, Beijing, China. jingliu@ccmu.edu.cn.

^# Contributed equally.

Abstract

Background: The availability of physical activity (PA) facilities in neighborhoods is hypothesized to influence cardiovascular disease (CVD), but evidence from individual-level long-term cohort studies is limited. We aimed to assess the association between neighborhood exposure to PA facilities and CVD incidence.

Methods: A total of 4658 participants from the Chinese Multi-provincial Cohort Study without CVD at baseline (2007-2008) were followed for the incidence of CVD, coronary heart disease (CHD), and stroke. Availability of PA facilities was defined as both the presence and the density of PA facilities within a 500-m buffer zone around the participants' residential addresses. Time-dependent Cox regression models were performed to estimate the associations between the availability of PA facilities and risks of incident CVD, CHD, and stroke.

Results: During a median follow-up of 12.1 years, there were 518 CVD events, 188 CHD events, and 355 stroke events. Analyses with the presence indicator revealed significantly lower risks of CVD (hazard ratio [HR] 0.80, 95% confidence interval ([CI] 0.65-0.99) and stroke (HR 0.76, 95% CI 0.60-0.97) in participants with PA facilities in the 500-m buffer zone compared with participants with no nearby facilities in fully adjusted models. In analyses with the density indicator, exposure to 2 and ≥ 3 PA facilities was associated with 35% (HR 0.65, 95% CI 0.47-0.91) and 28% (HR 0.72, 95% CI 0.56-0.92) lower risks of CVD and 40% (HR 0.60, 95% CI 0.40-0.90) and 38% (HR 0.62, 95% CI 0.46-0.84) lower risks of stroke compared with those without any PA facilities in 500-m buffer, respectively. Effect modifications between presence of PA facilities and a history of hypertension for incident stroke (P = 0.049), and a history of diabetes for incident CVD (P = 0.013) and stroke (P = 0.009) were noted.

Conclusions: Residing in neighborhoods with better availability of PA facilities was associated with a lower risk of incident CVD. Urban planning intervention policies that increase the availability of PA facilities could contribute to CVD prevention.

Keywords: Cardiovascular disease; Cohort study; Incidence; Neighborhood environment; Physical activity.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Asian People
Cardiovascular Diseases* / epidemiology
Cohort Studies
Exercise*
Fitness Centers
Humans
Neighborhood Characteristics*
Stroke* / epidemiology