Population Cardiovascular Health and Urban Environments: The Heart Healthy Hoods exploratory study in Madrid, Spain

Background: Our aim is to conduct an exploratory study to provide an in-depth characterization of a neighborhood’s social and physical environment in relation to cardiovascular health. A mixed-methods approach was used to... [ view full abstract ]

Background: Our aim is to conduct an exploratory study to provide an in-depth characterization of a neighborhood’s social and physical environment in relation to cardiovascular health. A mixed-methods approach was used to better understand the food, alcohol, tobacco and physical activity domains of the urban environment.

Methods: A median area of around 16,000 residents in Madrid was selected. Residents cardiovascular health data were obtained from the Madrid Primary Healthcare System. Quantitative audit tools were used to assess type and location of food outlets and food availability; tobacco and alcohol points of sales; characterization of streets for walking and cycling; and use of parks and public spaces. Eleven semi-structured interviews were conducted with key informants to help understanding the relationships between urban environment and cardiovascular behaviors.

Results: Electronic Health Records of the entire population of the area showed similar prevalence of risk factors compared to the rest of Madrid/Spain (prevalence of diabetes: 12%, hypertension: 34%, dyslipidemia: 32%, smoking: 10%, obesity: 20%). The food environment was dense and rich, with many small stores (n=44 stores) and a large food market with 112 stalls. Residents highlighted the importance of these small stores for buying healthy options. Alcohol and tobacco environments were also very dense (n=91 and 64 outlets, respectively), dominated by bars and restaurants (n=53 bars/restaurants) that also acted as food services. Neighbors emphasized the importance of drinking as a socialization mechanism. Open spaces were mostly used by seniors that remarked the importance of accessibility to these spaces and the availability of destinations to walk to.

Conclusion: This experience allowed testing and refining measurement tools, drawn from epidemiology, geography, sociology and anthropology, to better understand the urban environment in relation to cardiovascular health.