Associations of urban environment features with hypertension and blood pressure across 230 Latin American cities

Ione Avila-Palencia*, Daniel A. Rodríguez, J. Jaime Miranda, Kari Moore, Nelson Gouveia, Mika R. Moran, Waleska T. Caiaffa, Ana V. Diez Roux

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)
11 Downloads (Pure)


BACKGROUND: Features of the urban physical environment may be linked to the development of high blood pressure, a leading risk factor for global burden of disease. 

OBJECTIVES: We examined associations of urban physical environment features with hypertension and blood pressure measures in adults across 230 Latin American cities. 

METHODS: In this cross-sectional study we used health, social, and built environment data from the SALud URBana en América Latina (SALURBAL) project. The individual-level outcomes were hypertension and levels of systolic and diastolic blood pressure. The exposures were city and subcity built environment features, mass transit infrastructure, and green space. Odds ratios (ORs) and mean differences and 95% confidence intervals (CIs) were estimated using multilevel logistic and linear regression models, with single-and multiple-exposure models adjusted for individual-level age, sex, education, and subcity educational attainment. RESULTS: A total of 109,176 participants from 230 cities and eight countries were included in the hypertension analyses and 50,228 participants from 194 cities and seven countries were included in the blood pressure measures analyses. Participants were 18–97 years of age. In multiple-exposure models, higher city fragmentation was associated with higher odds of having hypertension (OR per standard deviation ðSDÞ increase = 1:11; 95% CI: 1.01, 1.21); presence (vs. no presence) of mass transit in the city was associated with higher odds of having hypertension (OR = 1:30; 95% CI: 1.09, 1.54); higher subcity population density was associated with lower odds of having hypertension (OR per SD increase = 0:90; 95% CI: 0.85, 0.94); and higher subcity intersection density was associated with higher odds of having hypertension [OR per SD increase = 1:09; 95% CI: 1.04, 1.15). The presence of mass transit was also associated with slightly higher systolic and diastolic blood pressure in multiple-exposure models adjusted for treatment. Except for the association between intersection density and hypertension, associations were attenuated after adjustment for country. An inverse association of greenness with continuous blood pressure emerged after country adjustment. 

DISCUSSION: Our results suggest that urban physical environment features—such as fragmentation, mass transit, population density, and intersection density—may be related to hypertension in Latin American cities. Reducing chronic disease risks in the growing urban areas of Latin America may require attention to integrated management of urban design and transport planning. 

Original languageEnglish
Article number027010
Number of pages10
JournalEnvironmental Health Perspectives
Issue number2
Publication statusPublished - 15 Feb 2022
Externally publishedYes

Bibliographical note

Funding Information:
The authors acknowledge the contribution of all Salud Urbana en América Latina (SALURBAL) project team members. We specially thank G. Yamada for his assistance with the statistical analyses. For more information on SALURBAL and to see a full list of investigators see The SALURBAL/Urban Health in Latin America project is funded by the Wellcome Trust [205177/Z/16/Z]. The authors have applied a CC BY 4.0 license to the contents of this publication.

Publisher Copyright:
© 2022, Public Health Services, US Dept of Health and Human Services. All rights reserved.

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis


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