Many factors can contribute to heart disease risk, such as diet, genetics and physical activity, just to name a few. But new evidence suggests that where a person lives may also play a role.
According to a new paper from Canada, inner-city populations in high-income countries may have a disproportionately high risk of heart disease.
The paper attributes this to many factors, including a lack of grocery stores, green space, and recreational facilities and higher rates of violence and mental illness in these areas.
"We have to think about how we can improve the neighborhood and urban environment in a way that reduces risk," said lead study author Stephen Hwang, MD, MPH, director for the Centre for Research on Inner City Health of St. Michael's Hospital in Toronto, in a press release.
According to Dr. Hwang and colleagues, a lack of grocery stores in urban areas may leave many inner-city residents with only the option to purchase food from convenience stores — which rarely have fresh, healthy foods. Urban areas that lack access to healthy foods are commonly referred to as “food deserts.”
Inner-city neighborhoods also tend to have fewer free exercise facilities than wealthier neighborhoods. This, combined with violent crime rates, may deter residents in these areas from exercising and contribute to poor heart health.
Dr. Hwang and colleagues also noted that inner-city populations in North America, Europe and the islands of the South Pacific have a higher incidence of mental illness.
Those with mental illness have a higher risk of developing heart disease due to the tendency for poor diet, sedentary lifestyle, lack of preventive treatment and the metabolic effects of psychiatric medication.
According to Dr. Hwang and colleagues, the use of mobile clinics, health coaching and case management approaches in inner-city areas has been moderately successful in improving heart health.
"You can try to develop programs that target marginalized individuals, but the challenge is that you also have to also think about the environment and consider the social world that the person lives in that also has an effect on them," Dr. Hwang said.
This paper was published Aug. 31 in The Canadian Journal of Cardiology.
Information on funding sources and conflicts of interest was not available at the time of publication.