Changes in walkability and incident CVD: a population-based cohort study covering 24 years

Background:
Changes in walkability may be linked to cardiovascular disease incidence, but longitudinal studies are lacking.

Purpose:
To investigate the relationship between changes in residential neighbourhood walkability and CVD incidence in adults in the Netherlands.

Methods:
We conducted a large-scale population-based cohort study. Using data from Statistics Netherland we included all Dutch residents aged ≥40y at baseline (2009), without a history of CVD, and who did not move house after baseline (n=3,019,069). A nationwide, objectively measured walkability index was calculated for Euclidean buffers of 500m around residential addresses for the years 1996, 2000, 2003, 2006 and 2008. To identify changes in neighbourhood walkability, latent class trajectory modelling was applied. Incident CVD between 2009-2019 was assessed using the Dutch Hospital Discharge Register and the National Cause of Death Register. Cox proportional hazards modelling was used to analyse associations between walkability trajectories and subsequent CVD incidence, adjusted for individual- and area-level sociodemographic characteristics.

Results:
Four distinct neighbourhood walkability trajectories were observed: a stable but relatively low walkability trajectory (Stable low, 91.1%), a stable but relatively higher walkability trajectory (Stable high, 0.6%), a relatively higher initial neighbourhood walkability which decreased over time (Decreasing, 1.7%), and relatively lower neighbourhood walkability which increased over time (Increasing, 6.5%). Compared to stable high walkability, individuals exposed to stable low, and increasing walkability, had a 5.1% (HR: 1.051; CI: 1.011–1.093) and a 4.9% (HR: 1.049; CI: 1.008–1.092) higher risk of any CVD during follow-up. Similar associations were observed for coronary heart disease and stroke, though not statistically significant. No significant associations were found for heart failure and CVD mortality.

Conclusions:
Adults exposed to stable low or increasing walkability trajectories in residential neighbourhoods had a higher risk of cardiovascular disease.

Practical implications:
The results emphasize the relevance of long-term urban planning considerations for cardiovascular health.