An ecological study of the relationship between urban built environment and cardiovascular hospital admissions (2004–2016) in an Asian developing country

• Published in: Social science & medicine (1982) Vol. 276; p. 113868
• Main Authors: Kwan, Soo Chen, Ismail, Rohaida, Ismail, Nor Halizam, Mohamed, Norlen
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.05.2021; Pergamon Press Inc
• Subjects: Attributes; Built environment; Cardiovascular disease; Cardiovascular diseases; Cerebrovascular disease; Coronary artery disease; Data; Disease; Ecological studies; Entropy; Health planning; Hospitalization; Hypertension; Indexes; Land use; Parks & recreation areas; Patient admissions; Population density; Property; Property values; Random effects; Recreation; Residential areas; Roads & highways; Urban areas; Urban planning
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2021.113868

This study aims to evaluate the relationship between urban built environment and hospital admissions from cardiovascular diseases in Kuala Lumpur, Malaysia. Hospital admission data from 2004 to 2016 for cardiovascular diseases were used with patient residential postcodes as the unit of analysis. Data was split into 2004–2009 (12,551 cases) and 2010–2016 (17,154 cases) periods corresponding to land use data. We used generalized linear mixed model to analyse population density, property value, entropy index, and the kernel density (800 m) of specific land use, bus and rail stations, and road junctions, with time period and postcodes as the random effects to generate incidence rate ratios (IRRs). Results indicated that entropy index and recreational area density were associated with fewer hypertensive disease and ischemic heart disease hospital admissions (IRR range: 0.49–0.68, 95%CI: 0.27, 0.97). Population density and property value were associated with fewer cerebrovascular disease hospital admissions (IRR range: 0.29–0.34, 95%CI: 0.11, 0.75). Contrarily, density of road junctions was associated with 2.5–6.3 times more hospital admissions for cardiovascular disease hospital admissions (IRR range: 2.53–6.34, 95%CI: 1.07,17.91). There were no significant association between hospital admission and density of residential area, undeveloped land, rail and bus stations. The shapes of relationships for all attributes were non-linear, and changed markedly at the third quartile except for recreational area density. The findings suggest that land use attributes have some protective effects on the cardiovascular disease admission cases as compared to the transport attributes. These findings have important merits for integrating health into urban planning. •Road junction density was associated with higher cardiovascular hospital admissions.•Public transit stations were not associated with the number of admission cases.•Land use mix was associated with lower female admissions compared to male.•Recreational density reduced cardiovascular hospital admissions across all quartiles