Association Between Perceived Neighborhood Characteristics and Carotid Artery Intima-Media Thickness: Cross-Sectional Results From the ELSA-Brasil Study

Objectives: This study aimed to investigate the association between perceived neighborhood characteristics and subclinical atherosclerosis in a large sample of adults, using cross-sectional data from the ELSA-Brasil (Brazilian Longitudinal Study of Adult Health).

Methods: Participants free of clinical coronary artery disease answered a questionnaire designed to assess their perceptions regarding 6 neighborhood dimensions: social cohesion, walkability, availability of healthy food, safety, witnessed violence, and personal victimization. The scores of each domain were used as independent variables. Common carotid intima-media thickness (CCIMT) was used as a dependent variable. Then linear regression models, adjusted by demographic, socioeconomic, and cardiovascular factors, were used.

Results: A total of 9,923 adults (mean age = 51.5 ± 8.9 years, 44% male, 55% white) were examined. In the univariate analysis, better walkability (β = –0.62, 95% confidence interval [CI]: –1.01 to –0.23; p = 0.002) and low witnessed violence (β = –1.95; 95% CI: –2.96 to -0.94; p < 0.0001) were associated with lower CCIMT, whereas low personal victimization was associated with higher CCIMT (β = 10.70; 95% CI: 4.55 to 16.85; p = 0.001). A borderline interaction between neighborhood domain and sex was found. Better social cohesion may be associated with larger CCIMT among women, whereas better safety was associated with lower CCIMT among men. Multiple imputation for missing CCIMT data showed similar results.

Conclusions: The perception of living in a more walkable environment and in a neighborhood where people witness fewer violent episodes can provide protection on the early phases of the atherosclerosis process. Less stress and the practice of physical activity may explain the protection.

Highlights

• In a sample of 9,923 Brazilian adults, CIMT was negatively associated with perceived good walkability and low witnessed violence, and positively correlated with low personal victimization in the analyses adjusted for demographic variables.
• These associations were no longer significant after adjusting for race, socioeconomic factors, and cardiovascular risk factors, meaning that these factors could play a mediating role.
• The stratified analyses by years of residency models and supplementary multiple-imputations model confirmed the same results.
• The perception of living in a more walkable environment and in a neighborhood where people witness fewer violent episodes can provide protection on the atherosclerosis process. Less stress and the engaging in physical activity may explain protection.