TY - JOUR
T1 - Favorable Neighborhood Walkability is Associated with Lower Burden of Cardiovascular Risk Factors Among Patients Within an Integrated Health System
T2 - The Houston Methodist Learning Health System Outpatient Registry
AU - Makram, Omar Mohamed
AU - Nwana, Nwabunie
AU - Nicolas, Juan C
AU - Gullapelli, Rakesh
AU - Pan, Alan
AU - Bose, Budhaditya
AU - Parekh, Tarang
AU - Al-Kindi, Sadeer
AU - Yahya, Tamer
AU - Hagan, Kobina
AU - Javed, Zulqarnain
AU - Patel, Kershaw
AU - Sharma, Garima
AU - Jones, Stephen L
AU - Cainzos-Achirica, Miguel
AU - Maddock, Jay E
AU - Nasir, Khurram
N1 - Funding Information:
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.
Publisher Copyright:
© 2023 Elsevier Inc.
PY - 2023/6
Y1 - 2023/6
N2 - This is the first study to investigate the relationship between neighborhood walkability and cardiovascular (CV) risk factors in the United States using a large population-based database. Cross-sectional study using data from 1.1 million patients over the age of 18 in the Houston Methodist Learning Health System Outpatient Registry (2016-2022). Using the 2019 WalkScore, patients were assigned to one of the 4 neighborhood walkability categories. The burden of CV risk factors (hypertension, diabetes, obesity, dyslipidemia, and smoking) was defined as poor, average, or optimal (>3, 1-2, 0 risk factors, respectively). We included 887,654 patients, of which 86% resided in the two least walkable neighborhoods. The prevalence of CV risk factors was significantly lower among participants in the most walkable neighborhoods irrespective of ASCVD status. After adjusting for age, sex, race/ethnicity, and socioeconomic factors, we found that adults living in the most walkable neighborhoods were more likely to have optimal CV risk profile than those in the least walkable ones (RRR 2.77, 95% CI 2.64-2.91). We observed an inverse association between neighborhood walkability and the burden of CV risk factors. These findings support multilevel health system stakeholder engagements and investments in walkable neighborhoods as a viable tool for mitigating the growing burden of modifiable CV risk factors.
AB - This is the first study to investigate the relationship between neighborhood walkability and cardiovascular (CV) risk factors in the United States using a large population-based database. Cross-sectional study using data from 1.1 million patients over the age of 18 in the Houston Methodist Learning Health System Outpatient Registry (2016-2022). Using the 2019 WalkScore, patients were assigned to one of the 4 neighborhood walkability categories. The burden of CV risk factors (hypertension, diabetes, obesity, dyslipidemia, and smoking) was defined as poor, average, or optimal (>3, 1-2, 0 risk factors, respectively). We included 887,654 patients, of which 86% resided in the two least walkable neighborhoods. The prevalence of CV risk factors was significantly lower among participants in the most walkable neighborhoods irrespective of ASCVD status. After adjusting for age, sex, race/ethnicity, and socioeconomic factors, we found that adults living in the most walkable neighborhoods were more likely to have optimal CV risk profile than those in the least walkable ones (RRR 2.77, 95% CI 2.64-2.91). We observed an inverse association between neighborhood walkability and the burden of CV risk factors. These findings support multilevel health system stakeholder engagements and investments in walkable neighborhoods as a viable tool for mitigating the growing burden of modifiable CV risk factors.
KW - Adult
KW - Cardiovascular Diseases/epidemiology
KW - Cross-Sectional Studies
KW - Delivery of Health Care, Integrated
KW - Heart Disease Risk Factors
KW - Humans
KW - Learning Health System
KW - Middle Aged
KW - Outpatients
KW - Protestantism
KW - Registries
KW - Risk Factors
KW - Walking
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U2 - 10.1016/j.cpcardiol.2023.101642
DO - 10.1016/j.cpcardiol.2023.101642
M3 - Review article
C2 - 36773946
VL - 48
JO - Current Problems in Cardiology
JF - Current Problems in Cardiology
SN - 0146-2806
IS - 6
M1 - 101642
ER -