The influence of geographic life environments on cardiometabolic risk factors: a systematic review, a methodological assessment and a research agenda

Authors

  • C. Leal,

    Corresponding author
    1. Inserm, U707, Research Unit in Epidemiology, Information Systems, and Modeling, Paris, France;
    2. Université Pierre et Marie Curie-Paris6, UMR-S 707, Paris, France;
    3. EHESP School of Public Health, Rennes, France
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  • B. Chaix

    1. Inserm, U707, Research Unit in Epidemiology, Information Systems, and Modeling, Paris, France;
    2. Université Pierre et Marie Curie-Paris6, UMR-S 707, Paris, France;
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C Leal, UMR-S 707 Inserm – UPMC-Paris6, Faculté de Médecine Saint-Antoine, 27 rue Chaligny, 75012 Paris, France. E-mail: leal@u707.jussieu.fr

Summary

Recent environmental changes play a role in the dramatic increase in the prevalence of cardiometabolic risk factors (CMRFs) such as obesity, hypertension, type 2 diabetes, dyslipidemias and the metabolic syndrome in industrialized countries. Therefore, identifying environmental characteristics that are associated with risk factors is critical to develop more effective public health interventions. We conducted a systematic review of the literature investigating relationships between characteristics of geographic life environments and CMRFs (131 articles). Most studies were published after 2006, relied on cross-sectional designs, and examined whether sociodemographic and physical environmental characteristics, and more recently service environment characteristics, were associated with obesity or, to a lesser extent, hypertension. Only 14 longitudinal studies were retrieved; diabetes, dyslipidemias and the metabolic syndrome were rarely analysed; and aspects of social interactions in the neighbourhood were critically underinvestigated. Environmental characteristics that were consistently associated with either obesity or hypertension include low area socioeconomic position; low urbanization degree; low street intersection, service availability and residential density; high noise pollution; low accessibility to supermarkets and high density of convenience stores; and low social cohesion. Intermediate mechanisms between environmental characteristics and CMRFs have received little attention. We propose a research agenda based on the assessment of underinvestigated areas of research and methodological limitations of current literature.

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