2023+AHA科学声明：社区和心血管健康（英文版）.pdf

《2023+AHA科学声明：社区和心血管健康（英文版）.pdf》由会员分享，可在线阅读，更多相关《2023+AHA科学声明：社区和心血管健康（英文版）.pdf（14页珍藏版）》请在周易易学书店|道易五术书社上搜索。

1、e1 Circ Cardiovasc Qual Outcomes.2023;16:e000124.DOI:10.1161/HCQ.0000000000000124 TBD 2023Circulation:Cardiovascular Quality and Outcomes is available at http:/www.ahajournals.org/journal/circoutcomesCirculation:Cardiovascular Quality and OutcomesAHA SCIENTIFIC STATEMENTNeighborhoods and Cardiovascu

2、lar Health:A Scientific Statement From the American Heart AssociationKiarri N.Kershaw,PhD,MPH,FAHA,Chair;Jared W.Magnani,MD,MSc,FAHA,Vice Chair;Ana V.Diez Roux,MD,PhD,MPH;Marlene Camacho-Rivera,ScD,MPH;Elizabeth A.Jackson,MD,FAHA;Amber E.Johnson,MD,MS,MBA;Gayenell S.Magwood,PhD,RN,FAHA;Lewis B.Morge

3、nstern,MD,FAHA;Jennifer J.Salinas,PhD;Mario Sims,PhD,FAHA;Mahasin S.Mujahid,PhD,MS,FAHA;on behalf of the Council on Quality of Care and Outcomes Research;Council on Epidemi-ology and Prevention;Council on Clinical Cardiology;Council on Hypertension;Council on Cardiovascular and Stroke Nursing;Counci

4、l on Peripheral Vascular Disease;and Council on the Kidney in Cardiovascular DiseaseABSTRACT:The neighborhoods where individuals reside shape environmental exposures,access to resources,and opportunities.The inequitable distribution of resources and opportunities across neighborhoods perpetuates and

5、 exacerbates cardiovascular health inequities.Thus,interventions that address the neighborhood environment could reduce the inequitable burden of cardiovascular disease in disenfranchised populations.The objective of this scientific statement is to provide a roadmap illustrating how current knowledg

6、e regarding the effects of neighborhoods on cardiovascular disease can be used to develop and implement effective interventions to improve cardiovascular health at the population,health system,community,and individual levels.PubMed/Medline,CINAHL,Cochrane Library reviews,and ClinicalTrials.gov were

7、used to identify observational studies and interventions examining or targeting neighborhood conditions in relation to cardiovascular health.The scientific statement summarizes how neighborhoods have been incorporated into the actions of health care systems,interventions in community settings,and po

8、licies and interventions that involve modifying the neighborhood environment.This scientific statement presents promising findings that can be expanded and implemented more broadly and identifies methodological challenges in designing studies to evaluate important neighborhood-related policies and i

9、nterventions.Last,this scientific statement offers recommendations for areas that merit further research to promote a deeper understanding of the contributions of neighborhoods to cardiovascular health and health inequities and to stimulate the development of more effective interventions.Key Words:A

10、HA Scientific Statements cardiovascular diseases health inequities neighborhood characteristics residential segregation The neighborhoods where individuals reside shape environmental exposures,access to resources,and opportunities.In empirical studies,neighborhoods are often evaluated using static m

11、easures assessed at a given point in time,but it is important to recognize that neighborhoods are dynamic.The composition of neigh-borhoods and the resources they provide or deny certain groups are shaped and reconfigured due to a constel-lation of historical and contemporary structural,cultural,and

12、 societal factors,including population decline,urban renewal and gentrification,immigration,and discrimina-tory or predatory lending practices.Neighborhood features relevant to cardiovascular health(CVH)include access to high-quality education,stable housing,public transportation,and jobs;prox-imity

13、 to environmental and industrial exposures,health care facilities,healthy foods,and spaces for congre-gation,exercise,and recreation;and environmen-tal stressors such as safety(Figure 1).1 Exposure to these factors may affect CVH through multiple path-ways,such as the development of poor CVH behavio

14、rs and health factors(eg,Lifes Essential 8),or through direct physiological processes tied to chronic stress and accelerated aging.1,2 The inequitable distribu-tion of essential resources for optimal health across neighborhoods exacerbates CVH inequities.Thus,interventions that affect and improve ne

15、ighborhood environments can potentially reduce the inequitable Supplemental Material is available at https:/www.ahajournals.org/doi/suppl/10.1161/HCQ.0000000000000124 2023 American Heart Association,Inc.Kershaw et al Neighborhoods and Cardiovascular HealthCirc Cardiovasc Qual Outcomes.2023;16:e00012

16、4.DOI:10.1161/HCQ.0000000000000124 TBD 2023 e2burden of cardiovascular disease(CVD)in disenfran-chised populations.This scientific statement highlights key studies identi-fied through literature searches and our collective expertise to broadly summarize the current state of this important area of re

17、search.It is not intended to provide an exhaustive review of the vast literature describing neighborhoods and CVH.Rather it is intended to serve as a roadmap illustrat-ing how current knowledge regarding the effects of neigh-borhoods on CVD can be used to develop and implement effective intervention

18、s to improve CVH at the population,health system,community,and individual levels(Figure 2).CONCEPTUALIZING AND MEASURING NEIGHBORHOODS AND THEIR CHARACTERISTICSThe definition of a neighborhood is context dependent and varies widely across countries,regions within coun-tries,and across the rural-urba

19、n continuum.The absence of a uniform definition of a neighborhood presents a challenge for researchers studying neighborhood health effects.Several approaches have been used to obtain an objective measure of a neighborhood.One approach relies on relatively fixed and well-defined geographic boundarie

20、s,such as census tracts,to create crude prox-ies for neighborhoods.These metrics are frequently used because they are convenient and can often be linked to publicly available data that use the same boundar-ies(eg,poverty levels or home ownership).Another is to define neighborhood boundaries by geosp

21、atially(eg,1-mile buffer surrounding the home),locally(eg,dis-tricts established by local governments),or culturally(eg,stakeholder-informed)established boundaries.Objec-tive measures of where people go to access resources or conduct activities(ie,activity spaces)have also been proposed as an altern

22、ative to traditional neighborhoods defined by their proximity to a persons home.Subjective approaches have been used to define a neighborhood as well,often with survey-based measures to character-ize specific aspects of a study participants neighborhood Figure 1.The multilevel and interacting factor

23、s that determine and shape the relation of the neighborhood with cardiovascular health and outcomes.The neighborhood environment is shaped by legacies of historical context and by structural racism,which in turn have perpetuated generational inequities with legal,political,cultural,and economic dime

24、nsions.Neighborhoods,as broadly defined by this scientific statement,affect the interpersonal and social environment,as manifested by social determinants of health.The cross-dimensional relations of cardiovascular health metrics across the life course are represented by the intersection of the axes.

25、e3Kershaw et al Neighborhoods and Cardiovascular HealthCirc Cardiovasc Qual Outcomes.2023;16:e000124.DOI:10.1161/HCQ.0000000000000124 TBD 2023(eg,walkability)either without specifying a frame of ref-erence or by providing one,such as the area within a 20-minute walk from home.Initial studies focused

26、 on neighborhood-level socio-economic disadvantage as a proxy for a host of specific neighborhood exposures associated with CVD risk.2 The measures of neighborhood disadvantage used in these studies typically come from administrative data(eg,US Census)and range from single variables like median hous

27、ehold income or percent of households living in poverty to multivariable indices constructed using mul-tiple socioeconomic variables.Including survey-based measures of aesthetics,healthy food availability,safety,and social cohesion in large cohort studies has allowed for a better understanding of th

28、e association of more specific features of the neighborhood environment on CVH and disease risk.The linkage of business loca-tion data,crime data,and data on the location of parks and public recreational spaces to participant address information has also been instrumental in the growth of this area

29、of research because these data can be added to any study with available address information.See T able 1 for commonly used data sources and measures.Many of these measures,and other less commonly used contextual measures,as well,are in the publicly available National Neighborhood Data Archive.22The

30、authors of this scientific statement recognize the complexity of defining the neighborhood and mea-suring the characteristics believed to affect CVH and health inequities.Therefore,we do not suggest an exclu-sive definition of the neighborhood.Instead,we sug-gest that investigators conceptualize the

31、 neighborhood Table 1.Commonly Used Data Sources and Measures for Assessing Neighborhood ConditionsNeighborhood condition Data sources Sample measures Socioeconomic status Census and American Community Survey Area Deprivation Index3;Neighborhood Socioeconomic Environment4Residential segregation Cens

32、us and American Community Survey Gi*statistic5,6;Index of Concentration at the Extremes7Crime and safety Crime reports(modeled or actual)Self-reportPolice-reported crime rates within a buffer around participants homes8,9MESA neighborhood safety scale8,10Collective efficacy Self-report Informal contr

33、ol scale11;social cohesion scale10,11Physical disorder Direct observationGoogle Street ViewSelf-reportSystematic social observations12,13MESA aesthetic quality scale10Food environment Commercially available business location databasesSelf-reportDensity of or distance to nearest food outlet14MESA hea

34、lthy food availability survey15,16Parks and physical activity resourcesCommercially available business and recreation area location databasesSelf-reportDensity of or distance to nearest park14Neighborhood amenities scale17Greenspace Satellite imageryGoogle Street ViewNormalized Difference Vegetation

35、 Index18Greenspace Exposure19Walkability Objective indicators like land use mix,street connectivitySelf-reportNational Walkability Index20Neighborhood Environment Walkability Scale21MESA indicates Multi-Ethnic Study of Atherosclerosis.rbr r M b r rr,r wr wR rrqRk rA-b rrb rFigure 2.Potential cardiov

36、ascular health effect of addressing neighborhood environments.Interventions and strategies addressing neighborhood factors have broad potential to meaningfully affect population,health system,community,and individual outcomes.The figure summarizes potential avenues by which neighborhood-level factor

37、s can be incorporated to improve cardiovascular health and promote health equity.Kershaw et al Neighborhoods and Cardiovascular HealthCirc Cardiovasc Qual Outcomes.2023;16:e000124.DOI:10.1161/HCQ.0000000000000124 TBD 2023 e4as appropriate for their research question.Furthermore,the selection of neig

38、hborhood measures should align with the conceptual framework guiding the research,the mechanism being studied,the consensus of stake-holders engaged in the research process,the potential limitations and threats to validity,and the feasibility of implementing the type of place-based intervention the

39、research is meant to inform.OBSERVATIONAL STUDIES EXAMINING THE CONTRIBUTION OF NEIGHBORHOODS TO CVH AND HEALTH INEQUITIESA large body of observational studies has documented associations between neighborhood conditions and car-diovascular outcomes independent of individual-level socioeconomic indic

40、ators and evaluated underlying mechanisms.The varied ways in which neighborhood exposures are measured make summarizing the asso-ciation of neighborhoods with CVH challenging,but several review articles have offered insights that we highlight below and summarize in Supplemental Table 1.Most studies

41、have been cross-sectional,but a growing number of longitudinal studies have improved our abil-ity to reduce bias and elucidate pathways through which geospatial factors operate.In addition,most studies have examined neighborhood environments at a single point in the life course.A few studies have ex

42、amined neighbor-hood exposures across the life course,but more research is needed to understand how life-stage neighborhood environments affect CVH.2325Neighborhood Physical and Social Environments and CVHA systematic review and meta-analysis of 36 longitudi-nal studies examined relations of the bui

43、lt environment(human-made surroundings including buildings and infrastructure)with cardiometabolic outcomes.26 Walk-ability was the most frequently measured exposure;it was associated with all 3 health outcomes included in the meta-analysis(obesity,hypertension,and type 2 dia-betes).There were an in

44、sufficient number of studies to perform meta-analyses for type 2 diabetes or hyperten-sion with any of the other built environment character-istics.Other systematic reviews have found consistent evidence supporting associations of walkability and greenspace with lower weight,type 2 diabetes,stroke,a

45、nd CVD.2729In a meta-analysis for obesity,significant associa-tions were found for urban sprawl and population density(the concentration of people and businesses within an area)and recreational facilities,but not route attributes(eg,street connectivity)or destinations(eg,proximity to transit stops).

46、26 In contrast,another review found that associations of access to facilities for physical and lei-sure activities were null or inconsistent for coronary heart disease,stroke,and type 2 diabetes.28 Systematic reviews have found null associations of the food environ-ment with CVD-related outcomes ove

47、rall,but some evi-dence linking the fast-food environment to higher weight and CVD.2729Living in neighborhoods with higher levels of air pol-lution has been linked to poorer endothelial function and adverse cardiovascular outcomes,including hospitaliza-tion and mortality.The most consistent findings

48、 are for short-and long-term exposure to ambient air pollution,specifically particulate matter 2.5 m.3032 Other air pol-lutants such as carbon monoxide,ozone,and particulate matter 10 have also been linked to hospitalization or mortality in patients with heart failure.32Although this area remains un

49、derstudied compared with the physical environment,a growing number of longitudinal studies have examined aspects of the neighborhood social environment,including socio-economic position,social cohesion(mutual trust and willingness to help one another),and social hazards(eg,crime)to cardiovascular ou

50、tcomes.1,33 The largest subset of these studies has focused on various mea-sures of neighborhood socioeconomic disadvantage and has demonstrated that adverse environments are associated with a higher incidence of CVD risk fac-tors and outcomes.Social cohesion has typically been measured by self-repo