Environmental drivers of CVD DALYs: 20–year macro–level evidence from China’s administrative data

Abstract

Cardiovascular diseases (CVD) account for 40% of deaths in China, with increasing prevalence associated with rapid urbanization and aging populations. Current research lacks comprehensive analysis of macro-scale environment-socioeconomic interactions. This study establishes a framework analyzing five environmental determinants of CVD disability-adjusted life years (DALYs): air quality (M1), green space accessibility (M2), public service facilities (M3), natural conservation status (M4), and transportation infrastructure (M5). Using 2000–2019 national and provincial data, we applied partial least squares structural equation modeling (PLS-SEM) to quantify direct/mediated effects, complemented by spatial heatmaps. Results reveal: (1) urbanization indirectly reduces CVD burden through improved transportation infrastructure (β = – 1.396, p < 0.1); (2) natural reserves provide the strongest protection (β = – 1.235, p < 0.01) with time-lagged effects; (3) significant synergy between green spaces and public services (r = 0.69); (4) high-risk provinces (e.g., Yunnan, Fujian) require geographically tailored strategies. The results can provide evidence-based planning strategies for CVD-mitigating urban development.