RT Journal Article
SR Electronic
T1 Does a physical activity supportive environment ameliorate or exacerbate socioeconomic inequities in incident coronary heart disease?
JF Journal of Epidemiology and Community Health
JO J Epidemiol Community Health
FD BMJ Publishing Group Ltd
SP 637
OP 642
DO 10.1136/jech-2020-215239
VO 75
IS 7
A1 Pedro Gullon
A1 Usama Bilal
A1 Jana A Hirsch
A1 Andrew G Rundle
A1 Suzanne Judd
A1 Monika M Safford
A1 Gina S Lovasi
YR 2021
UL http://jech.bmj.com/content/75/7/637.abstract
AB Background Efforts to reduce socioeconomic inequities in cardiovascular disease include interventions to change the built environment. We aimed to explore whether socioeconomic inequities in coronary heart disease (CHD) incidence are ameliorated or exacerbated in environments supportive of physical activity (PA).Methods We used data from the Reasons for Geographic and Racial Differences in Stroke study, which recruited US residents aged 45 or older between 2003 and 2007. Our analyses included participants at risk for incident CHD (n=20 808), followed until 31 December 2014. We categorised household income and treated it as ordinal: (1) US$75 000+, (2) US$35 000–US$74 000, (3) US$20 000–US$34 000 and (4) <US$20 000. We operationalised PA-supportive environments using characteristics within a 1 km residential buffer: walkable destinations density, PA facility density and proportion green land cover. We used Cox proportional hazards models to estimate the adjusted association of income with incident CHD, and tested effect modification by PA-supportive environment variables.Results We found a 25% (95% CI 1.17% to 1.34%) increased hazard of CHD per 1-category decrease in household income category. Adjusting for PA-supportive environments slightly reduced this association (HR=1.24). The income–CHD association was strongest in areas without walking destinations (HR=1.57), an interaction which reached statistical significance in analyses among men. In contrast, the income–CHD association showed a trend towards being strongest in areas with the highest percentage of green land cover.Conclusions Indicators of a PA supportive environment show divergent trends to modify socioeconomic inequities in CHD . Built environment interventions should measure the effect on socioeconomic inequities.Data may be obtained from a third party and are not publicly available. Data may be obtained from the REGARDS cohort committee at the University of Alabama at Birmingham on request.