Neighbourhood Walkability and Its Influence on Physical Activity and Cardiometabolic Disease: A Cross-Sectional Study in a Caribbean Small Island Developing State

Abstract

Introduction Cities and neighborhoods may provide opportunities for population-level environmental interventions to reduce physical inactivity and cardiometabolic risk. In this study, we describe the association between neighborhood walkability, physical activity (PA), and cardiometabolic outcomes, by linking data from a nationally representative survey of adults (25 years and older) collected in 2012-2013 with spatial data on built environment features in Barbados. Methods We estimated a walkability index for 45 neighborhoods using objectively measured built environment features (residential density, street connectivity, and land use mix). We used the Recent Physical Activity Questionnaire to capture time spent in outdoor walking, active commuting, moderate-to-vigorous PA (MVPA), and total PA. Our primary cardiometabolic outcome was a predicted 10-year cardiovascular risk (CVD) score, estimated using the American College of Cardiology/American Heart Association pooled cohort equation. Our secondary cardiometabolic outcomes were hypertension and diabetes. We explored the effect of neighborhood walkability on PA and cardiometabolic outcomes using several multivariable regression models (tobit and linear and logistic multi-level mixed effects), with the model choice depending on the structure of the outcome. Results The average time spent walking weekly for any purpose among participants was 75 minutes/week, time spent on active commuting was 15 minutes/week, and MVPA was 221 minutes/week. We estimated that the average 10-year CVD risk in the study population was 11.7% (95%CI 10.9-12.5). Our confounder-adjusted analyses showed positive linear relationships between neighborhood walkability and each PA outcome (p<0.05 in all cases), and a negative relationship between walkability and predicted 10-year CVD risk (p<0.001). Conclusion In our setting, adults residing in higher walkability neighborhoods spent more time engaged in PA, had a lower predicted 10-year CVD risk, and were less likely to have diabetes. Urban planners may consider shorter-term interventions, such as those on a microscale, which may provide additional ways to increase activity in a mostly fixed macroscale environment.

Keywords: 10-year cardiovascular risk; built environment; cardiovascular disease; caribbean; health of the nation survey; physical activity; recent physical activity questionnaire; small island developing states; urban planning.

Figure 1. Walkability Index Equation

WI = Walkability Index; RD= Residential Density; LUM= Land Use Mix; ID= 3-way Intersection density; z= Z-score; ED= Enumeration District

Figure 2. Spatial Distribution of Neighbourhood Built Environment Features and Walkability in Barbados

Figure 3. Comparison of IPEN Walkability Indices Across IPEN Study Sites With Sites in Barbados

IPEN: International Physical Activity and Environment Network; NZL: New Zealand; AUS: Australia; BEL: Belgium; BRA: Brazil; COL: Colombia; CZE: Czechia; DNK: Denmark; HKG: Hong Kong; MEX: Mexico; GBR: Great Britain; USA: United States of America; BRB: Barbados