Differences in built environmental exposures between three million older adults with and without cardiovascular diseases: a nationwide cross-sectional study in the Netherlands

BACKGROUND: This nationwide cross-sectional study examined differences in neighbourhood walkability, air pollution, noise, and food environment healthiness between older adults with and without cardiovascular disease (CVD) in rural and urban areas of the Netherlands.

METHODS: A cohort of 3,091,435 older adults (≥ 65 years) with (n = 1,174,256) and without (n = 1,917,179) CVD on January 1, 2018, was constructed by linking the Population Register and the Hospital Discharge Register. Neighbourhood walkability was assessed using an index, based on 1,000-meter Euclidean buffers around residences and combining data on population density, retail and service destination density, land use mix, street connectivity, green space density, sidewalk density, and public transport density. Food environment healthiness was assessed using the Food Environment Healthiness Index. Annual average concentrations of PM2.5, PM10, NO 2, elemental carbon (EC), and noise levels were also linked. Linear regression analyses stratified by five urbanization levels were adjusted for sociodemographic characteristics.

RESULTS: Nine of fourteen factors were less favorable in older adults with CVD than in those without CVD, including lower population density, retail and service destination density, land use mix, green space density, and food environment healthiness, and higher PM2.5, PM10, EC, and noise levels. Two factors were more favorable (i.e., lower NO 2 and higher public transport density), while three factors (i.e., neighbourhood walkability, street connectivity, and sidewalk density) showed no significant differences. Effect sizes were small, and exposure differences varied across urbanization levels without a consistent pattern.

CONCLUSIONS: Although the exposure differences are small, older adults with CVD generally lived in less favorable environmental conditions than those without CVD.

TRIAL REGISTRATION: Not applicable.