Influence of the Social Environment on Ideal Cardiovascular Health

Abstract

Background The environment plays a large role in the health of individuals; however, more research is needed to better understand aspects of the environment that most influence health. Specifically, our study examines how the social environment influences cardiovascular health (CVH). Methods and Results The social environment was characterized using measures of belonging and life and work stress in individuals, as well as nationally derived measures of marginalization, deprivation, economic status, and community well-being in neighborhoods. CVH was defined by the American Heart Association's Cardiovascular Health Index-a summed score of 7 clinical and behavioral components known to have the greatest impact on CVH. Data were obtained from the Canadian Community Health Survey 2015 to 2016 and multiple national data sources. Multilevel regression models were used to analyze the associations between CVH and the social environment. Overall, 27% of Canadians reported ideal CVH (6-7 score points), 68% reported intermediate CVH (3-5 score points), and 5% reported poor CVH (0-2 score points). The neighborhood environment contributed up to 7% of the differences in CVH between individuals. Findings indicated that residing in a neighborhood with greater community well-being (odds ratio [OR], 1.33 [95% CI, 1.26-1.41]) was associated with achieving higher odds of ideal CVH, while weaker community belonging (OR, 0.67 [95% CI, 0.62-0.72]) and residing in a neighborhood with greater marginalization (OR, 0.87 [95% CI, 0.82-0.91]) and deprivation (OR, 0.67 [95% CI, 0.64-0.69]) were associated with achieving lower odds of ideal CVH. Conclusions Aspects of individual-level social environment and residing in a neighborhood with a more favorable social environment were both independently and significantly associated with achieving ideal CVH.

Keywords: cardiovascular health; determinants of health; multilevel modeling; population health; social environment.

Figure 1. The CCVHI in Canadian adults, aged >20 years and without clinical heart disease.

Proportion of the population with ideal or poor cardiovascular health (individual components of the CCVHI) or ideal, intermediate, or poor cardiovascular health (overall CCVHI score). Canadian Community Health Survey (2015–2016). CCVHI indicates Canadian Cardiovascular Health Index; and CVH, cardiovascular health.

Figure 2

Representation of the association between individual‐level biologic and demographic factors, factors in individual‐ and neighborhood‐level social environment, and factors in the physical environment and the odds of achieving ideal cardiovascular health in Canadian adults, aged ≥20 years, from the Canadian Community Health Survey (2015–2016). All variables in each statistical model are graphed with a positive orientation and arranged on the vertical axis, bottom to top, on the basis of proximity to the individual and consistent with the “rainbows” in the original Dahlgren and Whitehead socioecological model included. The size of the bubble chart is proportional to the size of the proportional odds ratio; absence of a bubble indicates a non–statistically significant finding for that factor. A, Neighborhood defined as the Census Dissemination Area (Table 4, Models 1A and 1B). B, Neighborhood defined as the Census Subdivision (Table 5, Models 2A and 2B). C, Neighborhood defined as the Forward Sortation Area (Table 6, Model 3B). “Bubbles” are consistent with the color schema and order of factors (most proximal to most distal from the individual) in the Dahlgren and Whitehead “rainbow model.”, That is, results for individual‐level biologic and demographic factors are presented as the first grouping and coded with the color red; results for individual lifestyle factors are presented as the second grouping and coded with the color orange; results for social and community network factors (social environment, individual and neighborhood level) are presented as the third and fourth groupings, respectively, and coded with the color yellow; and results for living and working condition factors (physical environment, neighborhood level) are presented as the fifth group and coded with the color green. FSA indicates forward sortation area.