Environmental injustices play ‘crucial’ role in coronary heart disease, stroke risk
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Key takeaways:
- Environmental injustices may have a significant role in determining neighborhood-level CV risk.
- Residents of areas with more pollution and adverse socioeconomic factors had increased risk for CAD and stroke.
Environmental injustices such as air pollution and poor transport infrastructure may play a significant role in regional risk for cardiovascular disease and risk factors for it, researchers reported.
Additionally, there were notable differences in resident age and race/ethnicity in areas with the highest levels of adverse environmental factors and socioeconomic factors compared with areas with the lowest levels, according to data published in the Journal of the American Heart Association.
“Our study is one of the first to examine the impact of both social and environmental factors in combination and looked at the complex interplay between them,” Sarju Ganatra, MD, cardiologist and vice chair in the department of medicine for research and director of the cardio-oncology program and South Asian cardiometabolic program at Lahey Hospital and Medical Center in Burlington, Massachusetts, said in a press release. “Our aim is to empower the health care community to better inform patients about environmental factors they encounter daily. Patients, in turn, gain the ability to reduce their exposure to harmful environmental conditions, such as exposure to harmful chemicals and air pollutants to minimize health hazards and mitigate health risks.”
For this analysis, Ganatra, Sumanth Khadke, MD, research fellow at Lahey Hospital and Medical Center, and colleagues utilized data from the CDC 2022 Population-Level Analysis and Community Estimates (PLACES) database to obtain U.S. census tract prevalence of CVD and CVD risk factors. The census tracts were ranked using the 2022 Environmental Justice Index (EJI) into quartiles of social vulnerability: quartile 1 being the least vulnerable and quartile 4 being the most.
The EJI ranks census tracts domains categorized into three modules: the environmental burden module, the social vulnerability module and the health vulnerability module.
The environmental burden module accounted for air pollution, potentially hazardous and toxic sites, the built environment, transport infrastructure and water pollution. The social vulnerability module reported racial and ethnic minority status, socioeconomic factors, household characteristics and housing type. The health vulnerability module was not used in the present study.
EJI and CVD risk
Census tracts in the lowest EJI and environmental burden module quartile had the highest mean percentage of white and non-Hispanic individuals and adults aged 45 to 64 years and 65 years or older. The highest quartiles had the highest median percentages of Black individuals and adults aged 18 to 44 years.
From 2015 to 2019, researchers observed the highest rate of CAD (RR = 1.684; 95% CI, 1.66-1.708) and stroke (RR = 2.112; 95% CI, 2.078-2.147) in census tracts in the highest EJI quartile compared with the lowest.
Similarly, the rates of hypertension (RR = 1.561; 95% CI, 1.54-1.583), diabetes (RR = 2.024; 95% CI, 1.993-2.056), high cholesterol, obesity, lack of health insurance, less than 7 hours of sleep, no leisure-time physical activity and poor physical or mental health for more than 14 days were higher in census tracts in the highest EJI quartile compared with the lowest.
Although the researchers observed no significant difference between quartile 1 and 2 of the environmental burden module for many CVDs and CVD risk factors, the respective rates increased consistently from quartile 2 to 4, with higher risk for CAD (RR = 1.143; 95% CI, 1.127-1.159) and stroke (RR = 1.118; 95% CI, 1.102-1.135) in quartile 4 compared with quartile 1.
Environmental factors are ‘crucial and independent’
“I was amazed to see the tight links and complex interplay between social and environmental factors on health outcomes. We were able to demonstrate their ‘dual hit’ on health outcomes. And beyond that, we were more amazed by the fact that even after adjusting for socioeconomic factors, environmental factors played a crucial and independent role in determining various heart disease and other related health outcomes,” Ganatra said in the release.
Reference:
- Social, environmental factors may raise risk of developing heart disease and stroke. https://newsroom.heart.org/news/social-environmental-factors-may-raise-risk-of-developing-heart-disease-and-stroke. Published March 27, 2024. Accessed March 27, 2024.
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