Nwana Nwabunie, Makram Omar Mohamed, Nicolas Juan C, Pan Alan, Gullapelli Rakesh, Parekh Tarang, Javed Zulqarnain, Titus Anoop, Al-Kindi Sadeer, Guan Jian, Sun Kai, Jones Stephen L, Maddock Jay E, Chang Jenny, Nasir Khurram
Center for Health and Nature, Houston Methodist Research Institute, Houston, Texas, USA.
Center for Health Data Science and Analytics, Houston Methodist Research Institute, Houston, Texas, USA.
JACC CardioOncol. 2024 May 7;6(3):421-435. doi: 10.1016/j.jaccao.2024.03.009. eCollection 2024 Jun.
Modifiable cardiovascular risk factors constitute a significant cause of cardiovascular disease and mortality among patients with cancer. Recent studies suggest a potential link between neighborhood walkability and favorable cardiovascular risk factor profiles in the general population.
This study aimed to investigate whether neighborhood walkability is correlated with favorable cardiovascular risk factor profiles among patients with a history of cancer.
We conducted a cross-sectional study using data from the Houston Methodist Learning Health System Outpatient Registry (2016-2022) comprising 1,171,768 adults aged 18 years and older. Neighborhood walkability was determined using the 2019 Walk Score and divided into 4 categories. Patients with a history of cancer were identified through International Classification of Diseases-10th Revision-Clinical Modification codes (C00-C96). We examined the prevalence and association between modifiable cardiovascular risk factors (hypertension, diabetes, smoking, dyslipidemia, and obesity) and neighborhood walkability categories in cancer patients.
The study included 121,109 patients with a history of cancer; 56.7% were female patients, and 68.8% were non-Hispanic Whites, with a mean age of 67.3 years. The prevalence of modifiable cardiovascular risk factors was lower among participants residing in the most walkable neighborhoods compared with those in the least walkable neighborhoods (76.7% and 86.0%, respectively). Patients with a history of cancer living in very walkable neighborhoods were 16% less likely to have any risk factor compared with car-dependent-all errands neighborhoods (adjusted OR: 0.84, 95% CI: 0.78-0.92). Sensitivity analyses considering the timing of events yielded similar results.
Our findings demonstrate an association between neighborhood walkability and the burden of modifiable cardiovascular risk factors among patients with a medical history of cancer. Investments in walkable neighborhoods may present a viable opportunity for mitigating the growing burden of modifiable cardiovascular risk factors among patients with a history of cancer.
可改变的心血管危险因素是癌症患者心血管疾病和死亡的重要原因。最近的研究表明,社区步行便利性与普通人群中良好的心血管危险因素状况之间存在潜在联系。
本研究旨在调查社区步行便利性与有癌症病史的患者中良好的心血管危险因素状况是否相关。
我们使用休斯顿卫理公会学习健康系统门诊登记处(2016 - 2022年)的数据进行了一项横断面研究,该数据包含1171768名18岁及以上的成年人。社区步行便利性使用2019年步行评分来确定,并分为4类。通过国际疾病分类第十次修订版临床修订代码(C00 - C96)识别有癌症病史的患者。我们研究了可改变的心血管危险因素(高血压、糖尿病、吸烟、血脂异常和肥胖)在癌症患者中的患病率以及与社区步行便利性类别的关联。
该研究纳入了121109名有癌症病史的患者;56.7%为女性患者,68.8%为非西班牙裔白人,平均年龄为67.3岁。与居住在步行便利性最差社区的参与者相比,居住在步行便利性最佳社区的参与者中可改变的心血管危险因素患病率更低(分别为76.7%和86.0%)。与完全依赖汽车出行的社区相比,居住在步行便利性非常好的社区的有癌症病史的患者出现任何危险因素的可能性低16%(调整后的比值比:0.84,95%置信区间:0.78 - 0.92)。考虑事件发生时间的敏感性分析得出了类似结果。
我们的研究结果表明,社区步行便利性与有癌症病史的患者中可改变的心血管危险因素负担之间存在关联。对适宜步行社区的投资可能为减轻有癌症病史患者中不断增加的可改变心血管危险因素负担提供一个可行的机会。