Neighborhoods and Incident Cardiometabolic Disease in People With Disability.

Abstract

The age-adjusted prevalence of heart disease in people with disability is almost threefold that of people without disability. Social determinants of health are important for reducing cardiometabolic risk by providing opportunities for physical activity, healthy eating, and preventive health care. Yet, little research has examined how social determinants of health are associated with cardiometabolic disease in adults with physical disability. This study examined how neighborhood environments reduce or exacerbate risk of incident cardiometabolic disease in adults with physical disability. This was a retrospective cohort study using a sample of 27,224 Medicare beneficiaries (2008-2016) with a diagnosis of cerebral palsy, spina bifida, multiple sclerosis, or spinal cord injury, who received social security disability income prior to enrollment. Cardiometabolic disease was identified using International Classification of Diseases, Ninth Revision, Clinical Modification/ICD-10-CM codes over 3 years of follow-up. Measures of the neighborhood environment came from the National Neighborhood Data Archive and linked to individual residential ZIP codes. Cox regression models estimated hazard ratios for incident cardiometabolic disease, adjusting for age, sex, race/ethnicity, insurance coverage, and comorbid conditions. Analysis was conducted in 2023-2024. Of the 27,224 adults with physical disability, 49.5% had an incident cardiometabolic diagnosis over 3-year observation period. Net of covariates, residence in neighborhoods with more recreational facilities and less traffic was associated with reduced risk of incident cardiometabolic disease, whereas a greater density of grocery stores was associated with increased risk of disease. Findings highlight the importance of considering social determinants of health for mitigating or exacerbating the risk of cardiometabolic disease in adults with physical disability.