Abstract
BackgroundOur aim is to conduct an exploratory study to provide an in-depth characterization of a neighborhood’s social and physical environment in relation to cardiovascular health. A mixed-methods approach was used to better understand the food, alcohol, tobacco and physical activity domains of the urban environment.MethodsWe conducted this study in an area of 16,000 residents in Madrid (Spain). We obtained cardiovascular health and risk factors data from all residents aged 45 and above using Electronic Health Records from the Madrid Primary Health Care System. We used several quantitative audit tools to assess: the type and location of food outlets and healthy food availability; tobacco and alcohol points of sale; walkability of all streets and use of parks and public spaces. We also conducted 11 qualitative interviews with key informants to help understanding the relationships between urban environment and cardiovascular behaviors. We integrated quantitative and qualitative data following a mixed-methods merging approach.ResultsElectronic Health Records of the entire population of the area showed similar prevalence of risk factors compared to the rest of Madrid/Spain (prevalence of diabetes: 12 %, hypertension: 34 %, dyslipidemia: 32 %, smoking: 10 %, obesity: 20 %). The food environment was very dense, with many small stores (n = 44) and a large food market with 112 stalls. Residents highlighted the importance of these small stores for buying healthy foods. Alcohol and tobacco environments were also very dense (n = 91 and 64, respectively), dominated by bars and restaurants (n = 53) that also acted as food services. Neighbors emphasized the importance of drinking as a socialization mechanism. Public open spaces were mostly used by seniors that remarked the importance of accessibility to these spaces and the availability of destinations to walk to.ConclusionThis experience allowed testing and refining measurement tools, drawn from epidemiology, geography, sociology and anthropology, to better understand the urban environment in relation to cardiovascular health.Electronic supplementary materialThe online version of this article (doi:10.1186/s12874-016-0213-4) contains supplementary material, which is available to authorized users.
Highlights
Our aim is to conduct an exploratory study to provide an in-depth characterization of a neighborhood’s social and physical environment in relation to cardiovascular health
These behavioral risk factors and their associated increases in biological risk factors as hypertension, dyslipidemia and diabetes represent a large proportion of the excess Cardiovascular diseases (CVD) risk in populations
It has been estimated that there’s an opportunity to prevent even more CVD deaths in Spain if we can curb the increase in some risk factors such as diabetes [6]
Summary
Our aim is to conduct an exploratory study to provide an in-depth characterization of a neighborhood’s social and physical environment in relation to cardiovascular health. Cardiovascular diseases (CVD) remain the leading cause of death worldwide [1]. Their burden is projected to escalate in the following decades due to increased prevalence [2]. Individual risk factors directly associated with CVD include behavioral traits as smoking, unhealthy diets, lack of physical activity and excessive consumption of alcohol [5]. These behavioral risk factors and their associated increases in biological risk factors as hypertension, dyslipidemia and diabetes represent a large proportion of the excess CVD risk in populations. It has been estimated that there’s an opportunity to prevent even more CVD deaths in Spain if we can curb the increase in some risk factors such as diabetes [6]
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