Association between the Dutch Obesogenic Built-environmental CharacterisTics (OBCT) index and 14-year cardiovascular disease incidence: a population-based cohort study of 4.4 million adults

Background: The Dutch Obesogenic Built-environmental CharacterisTics (OBCT) index, which has been previously associated with higher BMI, waist circumference and increased prevalence of obesity, offers a composite measure of such exposures. This study investigated the association between OBCT index scores and 14-year CVD incidence in adults. Methods: This population-based cohort study included 4.4 million Dutch residents aged ≥40 years with no history of CVD as of January 1, 2006. Participants resided at the same address from January 1, 2004, to December 31, 2019, or until death. The OBCT index, ranging from 0 to 100, quantified the obesogenicity of participants' living environments at baseline. CVD outcomes included overall CVD incidence, coronary heart disease (CHD), stroke, and heart failure (HF). Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Findings: A 10-point higher OBCT index score was associated with a 1.1% (HR: 1.011; 95% CI: 1.009–1.013) higher risk of any CVD. Individuals in the highest quintile had a 4.9% (HR: 1.049; 95% CI: 1.038–1.060) higher risk of CVD compared to those in the lowest quintile, corresponding to 37 additional events per 10,000 persons at 10 years. A 10-point higher OBCT index was also associated with CVD mortality (HR: 1.010; 95% CI: 1.006–1.014) and for specific outcomes: CHD (1.1% higher risk), stroke (0.9% higher risk), and HF (1.2% higher risk). Associations were stronger in the highest income group and among individuals exposed to high air pollution levels. Interpretation: Living in a more obesogenic environment is associated with a higher 14-year risk of CVD. Although the effect sizes are modest at the individual level, their significance is amplified by the widespread nature of the exposures studied. Funding: This work is supported by EXPOSOME-NL. EXPOSOME-NL is a Dutch consortium funded through the Gravitation programme of the Dutch Ministry of Education, Culture, and Science and the Netherlands Organization for Scientific Research (NWO grant number 024.004.017).