Abstract
Health is increasingly subject to the complex interplay between the built environment, population composition, and the structured inequity in access to health-related resources across communities. The primary objective of this paper was to examine cardiometabolic disease (diabetes, cardiovascular diseases, stroke) markers and their prevalence across relatively small geographic units in the 500 largest cities in the United States. Using data from the American Community Survey and the 500 Cities Project, the current study examined cardiometabolic diseases across 27,000+ census tracts in the 500 largest cities in the United States. Earlier works clearly show cardiometabolic diseases are not randomly distributed across the geography of the U.S., but rather concentrated primarily in Southern and Eastern regions of the U.S. Our results confirm that chronic disease is correlated with social and built environment factors. Specifically, racial concentration (%, Black), age concentration (% 65+), housing stock age, median home value, structural inequality (Gini index), and weight status (% overweight/obese) were consistent correlates (p < 0.01) of cardiometabolic diseases in the sample of census tracts. The paper examines policy-related features of the built and social environment and how they might play a role in shaping the health and well-being of America’s metropolises.
Highlights
Health is increasingly subject to the complex interplay between the built environment and the pervasive structural and racial inequality across communities in the United States
Using data from the American Community Survey (ACS) [23] and the 500 Cities Project [24], the current study examines cardiometabolic diseases that are diet- and nutrition-related across 27,000+
While maps that have been generated by the 500 Cities Project clearly note important regional differences in the distribution of chronic metabolic diseases, we were interested in examining community-level correlates that are often discussed within the context of poor health outcomes—we were interested in whether there were any differences in chronic disease outcomes given certain population composition, housing, and socioeconomic characteristics across communities
Summary
Social and economic deprivation whether in the form of inadequate housing, limited access to healthy foods, social isolation, heightened levels of violence, or other forms of social disconnectedness, continue to provide a more complete understanding of health disparities in America [1,2,3,4,5]. In 2012, over 700,000 U.S deaths were attributed to cardiometabolic diseases such as heart disease, stroke, and type 2-diabetes [6,7]. Half of those deaths were associated with poor diet [6]. Mokdad and colleagues [9]
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