Recent environmental changes play a role in the dramatic increase in the prevalence of cardiometabolic risk factors (CMRFs) such as obesity, hypertension, type 2 diabetes, dyslipidemias and the metabolic syndrome in industrialized countries. Therefore, identifying environmental characteristics that are associated with risk factors is critical to develop more effective public health interventions. We conducted a systematic review of the literature investigating relationships between characteristics of geographic life environments and CMRFs (131 articles). Most studies were published after 2006, relied on cross-sectional designs, and examined whether sociodemographic and physical environmental characteristics, and more recently service environment characteristics, were associated with obesity or, to a lesser extent, hypertension. Only 14 longitudinal studies were retrieved; diabetes, dyslipidemias and the metabolic syndrome were rarely analysed; and aspects of social interactions in the neighbourhood were critically underinvestigated. Environmental characteristics that were consistently associated with either obesity or hypertension include low area socioeconomic position; low urbanization degree; low street intersection, service availability and residential density; high noise pollution; low accessibility to supermarkets and high density of convenience stores; and low social cohesion. Intermediate mechanisms between environmental characteristics and CMRFs have received little attention. We propose a research agenda based on the assessment of underinvestigated areas of research and methodological limitations of current literature.
Abstract-Recent studies have started to suggest that, beyond effects of individual socioeconomic profiles, socioeconomic characteristics of residential neighborhoods are independently associated with blood pressure. However, mechanisms involved in these associations remain unknown. To distinguish between different mechanisms, we investigated whether specific risk factors of hypertension (physical inactivity, alcohol consumption, smoking, body mass index, waist circumference, and resting heart rate) intervene as mediators in the associations between individual or neighborhood socioeconomic characteristics and systolic blood pressure. We relied on data from the RECORD Cohort Study (Residential Environment and CORonary heart Disease) on 5941 participants recruited in [2007][2008], aged 30 to 79 years, residing in 1824 neighborhoods in the Paris metropolitan area. Systolic blood pressure increased independently and regularly with both decreasing individual education and decreasing residential neighborhood education. Body mass index/waist circumference and resting heart rate mediated an appreciable share of the associations between education and blood pressure and, adding validity to the finding, were the 2 most significant mediators for the effects of both individual education and neighborhood education. We found that 52% (95% CI: 25% to 79%) of the association between neighborhood education and blood pressure was mediated by body mass index/waist circumference and 20% (95% CI: 5% to 36%) by resting heart rate. Future research will have to clarify the exact mechanisms through which body weight and shape and resting heart rate intervene as mediators in the associations between individual/neighborhood education and blood pressure. Key Words: blood pressure Ⅲ socioeconomic factors Ⅲ residence characteristics Ⅲ social environment Ⅲ heart rate Ⅲ obesity C onsidering socioeconomic characteristics is useful both in the clinical setting to improve risk stratification of patients at risk of hypertension and, from a public health perspective, to identify population-level determinants of blood pressure when defining interventions. 1 Regardless of the aim, recent studies suggest that a better assessment of socioeconomic differences in blood pressure may be obtained by considering social circumstances both at the individual level and at the residential neighborhood level. [2][3][4][5] To date, fewer studies have quantified neighborhood socioeconomic influences on blood pressure than on behavioral risk factors of cardiovascular diseases (smoking and physical inactivity) or obesity. 6 As recently emphasized, 7 knowledge useful for public health action is identifying the different mechanisms underlying associations between individual/neighborhood socioeconomic characteristics and blood pressure (eg, through known risk factors of hypertension) on which it would be possible to intervene to address social disparities in blood pressure. 1,8 However, on the one hand, the very few studies that investigated intermediate mechanisms throu...
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