Neighborhood environments and risk of incident atrial fibrillation: The Multi-Ethnic Study of Atherosclerosis

Current approaches to prevent atrial fibrillation are limited to risk factor control at the individual level. Identifying population-based strategies to reduce atrial fibrillation incidence is also important. Improving the neighborhood environment may represent one such potential strategy. Neighborhood physical environments include walkability, accessibility of physical activity resources, and availability of healthy foods. Neighborhood social environment features include aesthetic quality, safety, social cohesion and violent crime. Better neighborhood environments are associated with lower rates of atrial fibrillation risk factors, including obesity, hypertension, and diabetes mellitus. These findings suggest that risk of atrial fibrillation may be affected by large-scale efforts to improve the built environment. We examined the association of neighborhood physical and social environments, including walkability, healthy food availability, physical activity resources, and social cohesion and safety levels, with incident atrial fibrillation in a large, multiethnic population over time. The Multi-Ethnic Study of Atherosclerosis (MESA) recruited 6814 adults across the United States aged 45–84 years and free of clinically recognized cardiovascular disease between 2000 and 2002. Standardized questionnaires were used at baseline to obtain demographic information, level of education, annual household income, physical activity, alcohol consumption, smoking history, and medication usage, including lipid lowering therapy, anti-hypertensive, or anti-diabetic use. The neighborhood environment was characterized using both Geographic Information System (GIS) data and survey-based measures of neighborhood physical and social environments. The availability of physical activity establishments, popular walking destinations, and healthy food stores within one mile of participants’ homes was characterized using ArcGIS 9.3. Densities are expressed in units per square mile (henceforth, ‘‘densities’’ indicates units/mi). Relevant classifications and locations of stores and facilities were identified from Dun and Bradstreet data as compiled by Walls and Associates in the National Establishment Time Series database. Cumulative averages for each of these three variables were determined based on densities from each calendar year between 2000 and 2012. Survey-based neighborhood scales included the availability of healthy food, safety, social cohesion, and walkability where the participant was asked to rate their neighborhood within a mile of their home. Survey data collected from MESA participants was combined with data from participants in an external survey (the Community Survey) administered to other residents of neighborhoods in which MESA participants lived. Each score has a total possible range from 1 to 5, with a higher score representing a more favorable environment. Scores from the survey scales were summarized as the average of all responses from participants who lived within 1mi of each MESA participant’s home address. These 1-mi crude means