A multicomponent method assessing healthy cardiovascular urban environments: The Heart Healthy Hoods Index

Previous studies have examined the built environment mostly focusing on a single exposure construct (e.g. walkability) to examine its association with health outcomes. This study developed a multicomponent Heart Healthy Hoods Index to characterize heart-healthy urban environments and examined its relationship with the prevalence of cardiovascular disease (CVD) in Madrid, Spain. Using spatial methods, we generated two index models (model 0 unweighted and model 1 weighted) using the percentage of deaths for the main behavioral risk factors for CVD (diet, physical activity, alcohol, and tobacco environments). We performed global (Ordinal Least Square) and local (Geographically Weighed Regression) regression analyses to assess the relationship between both index models and CVD prevalence, and to identify the best index model. In the global analysis, both models showed a significant negative relationship with CVD prevalence. In the local analysis, Model 1 removed the spatial autocorrelation of residuals and showed the lowest values for the Akaike information criterion. This study provides evidence of a non-stationary relationship between the heart-healthy urban environment and CVD prevalence. The HHH index may be an effective tool to identify and prioritize geographical areas for CVD prevention.