Introduction: Rural residents are at a higher risk for early cardiovascular morbidity and mortality in midlife compared to urban populations. The neighborhood built environment (NBE), any human-made or modified feature of the physical environment, can be used to facilitate physical activity and improve health outcomes. However, the relationship between NBE features with cardiovascular (CV) risk factors in predominantly rural areas is unclear. Hypothesis: We evaluated whether NBE features conducive to physical activity are associated with healthier cardiometabolic risk factor measures in midlife. Methods: Data from Bogalusa Heart Study (2013-2016) participants were used to examine cross-sectional associations between NBE features and cardiometabolic risk factors including blood pressure, lipids, and glycemic markers. The Rural Active Living Assessment Street Segment audit tool and Google Street View were used to assess NBE features around participants’ residence. Scores were developed for path features, physical security, aesthetics, destinations, land use, and overall (high scores indicate feature promotes physical activity). Generalized estimating equations linear regression models accommodated for clustering within street segments and census tracts, and were adjusted for individual-level characteristics and neighborhood-level socioeconomic conditions. Results: A total of 1011 participants (mean age 48 years, 61% female, 33% Black) were analyzed. In fully adjusted models, a 1-point higher overall NBE score was associated with 0.5% higher high-density lipoprotein (p=0.035). A 1-point higher score for path features (p=0.006) and aesthetics (p=0.046) were also associated with 1% higher HDL. A 1-point higher destinations (p=0.040) score was associated with a 1.4% lower HDL. A 1-point higher aesthetics score was associated with a 0.7% lower hemoglobin A1c (p=0.038). A 1-point higher land use score was associated with 3.1% higher low-density lipoprotein (p=0.014). A 1-point higher physical security score was associated with a 0.7% lower systolic blood pressure when adjusted for individual-level covariates (p=0.047). Conclusion: Significant associations with cardiometabolic risk factors were identified for overall NBE, path features, aesthetics, destinations, and land use scores. Exploration into the mechanisms of these relationships may provide insight for informing rural communities to improve CV health outcomes.
Cueto et al. (Tue,) studied this question.