Is objectively measured exposure to built and natural environment associated with population-level cardiovascular disease mortality in Great Britain?
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background
Cardiovascular disease (CVD) causes one-third of global mortality, with modifiable risk factors such as unhealthy diet, sedentary behaviour, tobacco/alcohol use contributing to 80 % of CVD deaths. The built environment (BE) can influence CVD risk indirectly by shaping health behaviours and directly through environmental exposures like air pollution. While research has established connections between isolated environmental features and CVD, this study addresses significant research gaps in understanding how multiple BE characteristics influence CVD mortality across socioeconomic contexts, aiming to inform neighbourhood design to reduce both CVD and inequalities.
Methods
We modelled, for small areas across GB, tree cover, air pollution, walkability, densities of health-detrimental amenities (‘bads’) (e.g. fast-food outlets) and health-promoting amenities (‘goods’) (e.g. gyms), and income deprivation. Generalised linear models were used to assess associations between small area features and (sex-stratified) age-standardised CVD mortality rates (i.e. ICD-10 codes I00–I99), controlling for deprivation, urban-rural, country, and local authority. Combined models (i.e. models mutually adjusted for all BE features) identified the unique contribution of each feature while accounting for those that ‘co-located’. Interaction analysis was performed to examine variations by income deprivation.
Results
A slight increase in CVD mortality risk was associated with greater ‘goods’ densities (female mortality ratio (MR):1.005 (CIs:1.003–1.007), p < 0.001, male MR:1.005 (CIs:1.003–1.006), p < 0.001), and higher air pollution (female MR:1.006 (CIs:1.003–1.009), p < 0.001, male MR:1.008 (CIs:1.005–1.009), p < 0.001). A slight decrease in CVD mortality was associated with higher walkability for females (MR:0.996 (CIs:0.992–0.999), p = 0.034) and tree cover for males (MR:0.999 (CIs:0.998–0.999), p = 0.007). Higher air pollution levels and ‘bads’ were associated with higher male CVD mortality in deprived areas.
Conclusion
Findings have clear policy implications, suggesting prioritisation of reductions in air pollution—particularly in deprived areas—while promoting walkability and tree cover to reduce health inequalities. Unexpected positive associations between ‘goods’ and mortality highlight that complex neighbourhood effects warrant further study.
Cardiovascular disease (CVD) causes one-third of global mortality, with modifiable risk factors such as unhealthy diet, sedentary behaviour, tobacco/alcohol use contributing to 80 % of CVD deaths. The built environment (BE) can influence CVD risk indirectly by shaping health behaviours and directly through environmental exposures like air pollution. While research has established connections between isolated environmental features and CVD, this study addresses significant research gaps in understanding how multiple BE characteristics influence CVD mortality across socioeconomic contexts, aiming to inform neighbourhood design to reduce both CVD and inequalities.
Methods
We modelled, for small areas across GB, tree cover, air pollution, walkability, densities of health-detrimental amenities (‘bads’) (e.g. fast-food outlets) and health-promoting amenities (‘goods’) (e.g. gyms), and income deprivation. Generalised linear models were used to assess associations between small area features and (sex-stratified) age-standardised CVD mortality rates (i.e. ICD-10 codes I00–I99), controlling for deprivation, urban-rural, country, and local authority. Combined models (i.e. models mutually adjusted for all BE features) identified the unique contribution of each feature while accounting for those that ‘co-located’. Interaction analysis was performed to examine variations by income deprivation.
Results
A slight increase in CVD mortality risk was associated with greater ‘goods’ densities (female mortality ratio (MR):1.005 (CIs:1.003–1.007), p < 0.001, male MR:1.005 (CIs:1.003–1.006), p < 0.001), and higher air pollution (female MR:1.006 (CIs:1.003–1.009), p < 0.001, male MR:1.008 (CIs:1.005–1.009), p < 0.001). A slight decrease in CVD mortality was associated with higher walkability for females (MR:0.996 (CIs:0.992–0.999), p = 0.034) and tree cover for males (MR:0.999 (CIs:0.998–0.999), p = 0.007). Higher air pollution levels and ‘bads’ were associated with higher male CVD mortality in deprived areas.
Conclusion
Findings have clear policy implications, suggesting prioritisation of reductions in air pollution—particularly in deprived areas—while promoting walkability and tree cover to reduce health inequalities. Unexpected positive associations between ‘goods’ and mortality highlight that complex neighbourhood effects warrant further study.
Date Issued
2025-12-01
Date Acceptance
2025-10-23
Citation
SSM - Population Health, 2025, 32
ISSN
2352-8273
Publisher
Elsevier BV
Journal / Book Title
SSM - Population Health
Volume
32
Copyright Statement
© 2025 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
License URL
Publication Status
Published
Article Number
101875
Date Publish Online
2025-10-25