Introduction:
Studies suggest living in a more walkable neighborhood may protect against cardiovascular disease risk factors such as hypertension (HTN) and diabetes mellitus (DM) by encouraging physical activity. Walkable neighborhoods, however, often carry higher levels of traffic-related air pollution. Little is known regarding whether synergistic effects may exist between walkability and air pollution on these risk factors.
Hypothesis:
We hypothesized that the association between traffic-related air pollution, hypertension, and diabetes mellitus would be stronger in more walkable areas.
Methods:
We drew a cross-sectional sample of individuals ages 40-74 on January 1, 2008 from the CANHEART cohort. HTN and DM were ascertained using validated algorithms. Walkability (quintiles, Q5 highest, Q1 lowest) was measured using a validated index which has previously been shown to be inversely associated with obesity and diabetes. Exposure to nitrogen dioxide, a valid marker for traffic-related air pollution, was assessed using a land use regression models. The associations were tested using logistic regression with cluster-robust standard errors, adjusting for age, sex, area-level income, ethnicity, and comorbidities.
Results:
In total, 2,618,584 individuals were included in the analysis (mean (SD) age = 53.2 (9.2), 52% female). Walkability was inversely associated with odds for HTN (Q5 vs. Q1 OR = 0.80, 95% CI: 0.79, 0.82) and DM (Q5 vs. Q1 OR = 0.89, 95% CI: 0.87, 0.91), while NO
2
was positively associated with each (HTN: OR = 1.02 per 10 ppb (1.01, 1.03); DM: OR = 1.11 per 10 ppb (1.09, 1.13)). We observed significant interactions between walkability and NO
2
on odds for HTN and DM, with stronger NO
2
associations in the most walkable neighborhoods (Fig. 1).
Conclusions:
We observed significant interactions between traffic-related air pollution and walkability on odds for HTN and DM. This finding suggests that benefits from living in more walkable neighborhoods may be offset by stronger negative associations with air pollution.
Cardiovascular Disease Risk Factors: Hypertension, Diabetes Mellitus and Obesity among Tabuk Citizens in Saudi Arabia
