Impact of neighbourhood and environmental factors on the risk of incident cardiovascular disease: a systematic review and meta-analysis

We aimed to study the association of five key neighbourhood exposures in large cohort studies and risk of incident cardiovascular disease (CVD).

We conducted a systematic search of MEDLINE, The Cochrane Library, Web of Science, and Embase from database inception to 20th October 2024. Included studies reported both incident (first-time) CVD diagnosis and neighbourhood exposures across five domains: retail environment, health services, physical environment, pollution, and neighbourhood deprivation. A random-effects meta-analysis was performed to estimate pooled risk of CVD across domains. Of 39 studies included in the systematic review, 28 qualified for meta-analysis representing over 41 million people. The most frequently examined exposures were air pollution (n = 17), followed by noise pollution (n = 9), socioeconomic (n = 6), green and blue spaces (n = 3), and health and retail environments (n = 4). Higher concentrations of particulate matter 2.5 {PM_2.5; hazard ratio (HR): 1.16 [95% confidence interval (95% CI): 1.09–1.24] per 10 µg/m³ increase}, higher nitrogen dioxide [NO₂; HR: 1.05 (95% CI: 1.02–1.07) per 10 ppb increase], road traffic noise [risk ratio (RR): 1.03 (95% CI: 1.02–1.05) per 10 dB increase], and high neighbourhood-level deprivation [RR: 1.24 (95% CI: 1.17–1.31) vs. low] were each associated with increased risk of incident CVD development.

Our findings indicate a modest yet significant increase in CVD risk associated with elevated levels of air pollution, road noise, and neighbourhood deprivation, emphasizing these exposures as consequential targets for policy intervention.