Impact of neighbourhood and environmental factors on the risk of incident cardiovascular disease: a systematic review and meta-analysis.

Abstract

Aims: We aimed to study the association of five key neighbourhood exposures in large cohort studies and risk of incident cardiovascular disease (CVD).

Methods: We conducted a systematic search of MEDLINE, The Cochrane Library, Web of Science, and Embase from database inception to 20th October 2024. Included studies reported both incident (first-time) CVD diagnosis and neighbourhood exposures across five domains: retail environment; health services; physical environment; pollution; and neighbourhood deprivation. A random-effects meta-analysis was performed to estimate pooled risk of CVD across domains.

Results: Of 39 studies included in the systematic review, 28 qualified for meta-analysis representing over 41 million people. The most frequently examined exposures were air pollution (n=17), followed by noise pollution (n=9), socioeconomic (n=6), green and blue spaces (n=3), and health and retail environments (n=4). Higher concentrations of particulate matter 2.5 (PM2.5; HR: 1.16 [95% CI: 1.09-1.24] per 10 µg/m³ increase), higher nitrogen dioxide (NO2; HR: 1.05 [95% CI: 1.02-1.07] per 10 ppb increase), road traffic noise (RR: 1.03 [95% CI: 1.02-1.05] per 10dB increase), and high neighbourhood-level deprivation (RR: 1.24 [95% CI: 1.17-1.31] vs. low) were each associated with increased risk of incident CVD development.

Conclusion: Our findings indicate a modest yet significant increase in CVD risk associated with elevated levels of air pollution, road noise and neighbourhood deprivation, emphasising these exposures as consequential targets for policy intervention.