摘要：AbstractBackgroundLiving in unwalkable neighborhoods has been associated with heightened risk for diabetes and hypertension. However, highly walkable environments may have higher concentrations of traffic-related air pollution, which may contribute to increased cardiovascular disease risk. We therefore aimed to assess how walkability and traffic-related air pollution jointly affect risk for hypertension and diabetes.MethodsWe used a cross-sectional, population-based sample of individuals aged 40–74 years residing in selected large urban centres in Ontario, Canada on January 1, 2008, assembled from administrative databases. Walkability and traffic-related air pollution (NO2) were assessed using validated tools and linked to individuals based on neighborhood of residence. Logistic regression was used to estimate adjusted associations between exposures and diagnoses of hypertension or diabetes accounting for potential confounders.ResultsOverall, 2,496,458 individuals were included in our analyses. Low walkability was associated with higher odds of hypertension (lowest vs. highest quintile OR = 1.34, 95% CI: 1.32, 1.37) and diabetes (lowest vs. highest quintile OR = 1.25, 95% CI: 1.22, 1.29), while NO2exhibited similar trends (hypertension: OR = 1.09 per 10 p.p.b., 95% CI: 1.08, 1.10; diabetes: OR = 1.16, 95% CI: 1.14, 1.17). Significant interactions were identified between walkability and NO2on risk for hypertension (p p ConclusionsWalkability and traffic-related air pollution interact to jointly predict risk for hypertension and diabetes. Although walkable neighborhoods appear to have beneficial effects, they may accentuate the harmful effects of air pollution on cardiovascular risk factors.Highlights•Increasing walkability was associated with increasing traffic-related air pollution.•Walkability and air pollution mutually confounded associations with CVD risk factors.•Interactions were observed between walkability, air pollution, and CVD risk factors.
关键词：AbbreviationsBMIbody mass index;CANHEARTCardiovascular Health in Ambulatory Care Research Team cohort;COPDchronic obstructive pulmonary disease;LURland use regression;NO2nitrogen dioxide;PMparticulate matter;p.p.b.parts per billion;Walkability;Air pollution;Diabetes;Hypertension;NO2
