Environmental factors and cardiovascular diseases: The association of income inequality and green spaces in elderly residents of São Paulo, Brazil

Abstract

Objective: We aimed to analyse the individual and contextual determinants associated with cardiovascular diseases (CVDs) morbidity among the elderly. Methods: The sample consisted of 1333 individuals aged 60 or older residing in the city of São Paulo, from the Health, Welfare and Aging (SABE) study survey performed in 2010. The association between CVD with both income inequality and green spaces was analysed using Bayesian multilevel models, controlling for individual and contextual factors. Results: We found a significant association between income inequality and green spaces, and risk of CVD. In comparison to elderly residents in areas with lowincome inequality, there was an increased risk for CVD among those residing in the medium low (OR=1.35, 95% CI 1.15 to 1.59), medium high (OR=2.71, 95% CI 2.18 to 3.36) and high (OR=1.43, 95% CI 1.14 to 1.79) quartiles of income inequality. Those living in medium-low (OR=0.44, 95% CI 0.39 to 0.49), medium-high (OR=0.56, 95% CI 0.48 to 0.65) and high (OR=0.48, 95% CI 0.43 to 0.55) green spaces levels had lower risk of CVD. Conclusions: These findings highlight the importance of area-level characteristics on CVD risk and the need to develop healthcare policies focused on the effect of individual and contextual characteristics.