Favorable Neighborhood Walkability is Associated With Lower Burden of Cardiovascular Risk Factors Among Patients Within an Integrated Health System: The Houston Methodist Learning Health System Outpatient Registry

The global prevalence of cardiovascular diseases (CVD) has doubled over the last 30 years, reaching more than 500 million cases in 2019, with the United States (US) having the fourth-highest number of CVD deaths.1 In the US specifically, the prevalence of traditional cardiovascular (CV) risk factors, particularly those strongly linked to diet and sedentary behaviors (eg, obesity and diabetes) is increasing rapidly.2,3 Despite population-level efforts and pharmacological innovations over time, it has become clear that additional upstream interventions (primordial preventive strategies) need to be considered.

A multitude of observational studies has shown a link between the socioeconomic status of individuals and CV outcomes.4, 5, 6, 7, 8 These studies focused on a few aspects of socioeconomic status such as poverty, homelessness, and education attainment. In contrast, neighborhood health effects, as part of socioeconomic status, have not only been understudied. Particularly, neighborhood resources for physical activity and healthy food availability can directly affect both CV outcomes and risk factors.9, 10, 11, 12, 13 Importantly, studies conducted in other countries suggest that neighborhood walkability, a measure of how walkable the area is, can improve physical activity and a healthy lifestyle. A recent study in Japan found that walkability was associated with lower CV mortality rates.14 Another study in Canada has shown a significant decrease in overweight and obesity prevalence in areas with higher walkability.15

Neighborhood walkability is particularly important in the US since only 55% of US adults meet the guidelines for aerobic physical activity and also given the very high rates of obesity.16,17

Nevertheless, to our knowledge, no previous studies have investigated the relationship between walkability and CV risk factors in the United States using a large population-based database. In this study, we aimed to investigate this relationship among a large diverse population of Houston, Texas using an integrated health system.

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