The association of neighborhood walkability and food environment with incident cardiovascular disease in The Maastricht Study

Abstract

Built environmental determinants can drive lifestyle behaviors and potentially reduce chronic disease prevalence. Few studies exist that have examined the association of obesogenic environment exposures with cardiovascular disease (CVD) outcomes. We aim to specifically examine the association between neighborhood walkability, food environment and CVD. Data from 6117 Dutch participants of The Maastricht Study, between the ages of 40 and 75 years in the Netherlands were examined. Home addresses were linked to geographic information systems data from the Geoscience and Health Cohort Consortium to create neighborhood exposures of walkability and food environment. Perceived walkability was obtained from the Abbreviated Neighborhood Environment Walkability Scale. An 11-year incidence of CVD was defined by self-reported non-fatal or fatal event (as registered by Statistics Netherlands). Cox regression models examined the association of environment exposures with incident CVD adjusted for demographic and socioeconomic variables. There was lower incidence of CVD using the perceived walkability questionnaire in those living in the most walkable neighborhood (Quartile 4 HR: .77; 95% CI = .62, .97) but not using the objective walkability index (Quartile 4 HR: 1.10; 95% CI = .89, 1.38). There was no association between the food environment and incident CVD (Quartile 4 HR: .82; 95% CI = .65, 1.04). The discordant findings between walkability measures suggest integrating residential feedback and accounting for lived experiences should be prioritized by policymakers when designing equitable neighborhoods to prevent CVD.