The role of environmental access to exercise opportunities in cardiovascular mortality: evidence from a nationwide study

Background Environmental access to exercise opportunities plays a crucial role in determining the level of physical activity within a population. However, it is unclear how environmental factors contribute to disparities in physical activity and health outcomes. We explored the associations between...

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Published in:BMC medicine Vol. 23; no. 1; pp. 228 - 11
Main Authors: Wang, Xiaowen, Gu, Yongshi, Wang, Ying, Qiu, Yuqing, Chen, Tianling, Hopke, Philip K., Zhang, Kai, Lin, Shao, Qu, Yanji, Lin, Ziqiang, Deng, Xinlei, Sun, Jie, Zhu, Shuming, Deng, Xueqing, Li, Sizhe, Lin, Xian, Du, Zhicheng, Hao, Yuantao, Zhang, Wangjian
Format: Journal Article
Language:English
Published: London BioMed Central 18.04.2025
BioMed Central Ltd
Springer Nature B.V
BMC
Subjects:
Access to exercise opportunities
Adult
Age
Aged
Biomedicine
Cardiovascular disease
Cardiovascular diseases
Cardiovascular Diseases - mortality
Comparative analysis
Demographics
Demography
Diabetes
Disease prevention
Environmental aspects
Environmental factors
Exercise
Family income
Female
Females
Generalized linear models
Health aspects
Heart attack
Heart diseases
Humans
Income inequality
Ischemia
Level indicators
Male
Medical research
Medicine
Medicine & Public Health
Medicine, Experimental
Middle Aged
Minority & ethnic groups
Mortality
Myocardial infarction
Nationwide study
Patient outcomes
Physical activity
Physical fitness
Physical inactivity
Population
Primary care
Race
Risk factors
Risk management
Rural areas
Statistical models
Statistics
Stratification
Subgroups
United States
United States - epidemiology
Urbanization
United States
United States > US
Nationwide study
Cardiovascular disease
Physical inactivity
Access to exercise opportunities
ISSN:1741-7015, 1741-7015
Online Access:Get full text
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Summary:Background Environmental access to exercise opportunities plays a crucial role in determining the level of physical activity within a population. However, it is unclear how environmental factors contribute to disparities in physical activity and health outcomes. We explored the associations between county-level access to exercise opportunities and cardiovascular disease (CVD) mortality across US counties. Methods We conducted an ecological analysis using aggregated data from two primary sources: the County Health Rankings and Roadmaps data and CDC WONDER mortality data. We compared county-level age-adjusted CVD mortality across county-level quartiles of access to exercise opportunities and physical inactivity. Stratification was performed based on age, sex, race, and urbanization variables. The rate ratio (RR) for CVD mortality was also calculated using generalized linear models. Results We observed significant variations in CVD mortality across different levels of exercise opportunities access and physical inactivity, which was consistent across all demographic subgroups ( P  < 0.001). Access to exercise opportunities was significantly associated with a reduced risk of CVD mortality (RR = 0.93 [0.91–0.95]), and the association was most pronounced for acute myocardial infarction (AMI) mortality (RR, 0.80 [0.76–0.85]). The county-level physical inactivity was significantly associated with an increased risk of CVD mortality (RR, 1.16 [1.14–1.17]), especially for ischemic heart disease (IHD) (RR, 1.35 [1.31–1.38]) and AMI (RR, 1.32 [1.25–1.38]). All demographic subgroups demonstrated similar benefits in reducing the risk of CVD by improving the county-level indicators of physical activity. Conclusions Counties have the potential to make significant environmental strides in improving the cardiovascular health of their populations by enhancing access to exercise opportunities in the context of urbanization.
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ISSN:1741-7015
1741-7015
DOI:10.1186/s12916-025-04060-8