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Environmental factors and cardiovascular diseases: the association of income inequality and green spaces in elderly residents of Sao Paulo, Brazil
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We aimed to analyse the individual and contextual determinants associated with cardiovascular diseases (CVDs) morbidity among the elderly. Methods: The sample consisted of 1333 individuals aged 60 or older residing in the city of Sao Paulo, from the Health, Welfare and Aging (SABE) study survey performed in 2010. The association between CVD with both income inequality and green spaces was analysed using Bayesian multilevel models, controlling for individual and contextual factors. Results: We found a significant association between income inequality and green spaces, and risk of CVD. In comparison to elderly residents in areas with low-income inequality, there was an increased risk for CVD among those residing in the medium-low (OR=1.35, 95% CI 1.15 to 1.59), medium-high (OR=2.71, 95% CI 2.18 to 3.36) and high (OR=1.43, 95% CI 1.14 to 1.79) quartiles of income inequality. Those living in medium-low (OR=0.44, 95% CI 0.39 to 0.49), medium-high (OR=0.56, 95% CI 0.48 to 0.65) and high (OR=0.48, 95% CI 0.43 to 0.55) green spaces levels had lower risk of CVD. Conclusions: These findings highlight the importance of area-level characteristics on CVD risk and the need to develop healthcare policies focused on the effect of individual and contextual characteristics.