Urban imperviousness and carotid intima-medial thickness: Evidence from the Coronary Artery Risk Development in Young Adults (CARDIA) study

Dandan Zhao; Jie Yao; Yuanfei Li; David R Jacobs Jr; Tao Gao; Linda H Nie; Colin O Wu; Umit Tokac; Shuang Li; Hui Zhao; Donald Lloyd-Jones; Lifang Hou; Kai Zhang

doi:10.1016/j.scitotenv.2025.179376

Urban imperviousness and carotid intima-medial thickness: Evidence from the Coronary Artery Risk Development in Young Adults (CARDIA) study

Sci Total Environ. 2025 May 25:978:179376. doi: 10.1016/j.scitotenv.2025.179376. Epub 2025 Apr 18.

Authors

Dandan Zhao¹, Jie Yao², Yuanfei Li¹, David R Jacobs Jr³, Tao Gao⁴, Linda H Nie⁵, Colin O Wu⁶, Umit Tokac⁷, Shuang Li⁸, Hui Zhao⁹, Donald Lloyd-Jones⁴, Lifang Hou⁴, Kai Zhang¹⁰

Affiliations

¹ Department of Sociology, University at Albany, State University of New York, Albany, NY, USA.
² Department of Epidemiology and Biostatistics, College of Integrated Health Sciences, University at Albany, State University of New York, Rensselaer, NY, USA.
³ Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
⁴ Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
⁵ School of Health Sciences, Purdue University, West Lafayette, IN, USA.
⁶ Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
⁷ Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
⁸ Department of Social Work and Sociology, John R. and Kathy R. Hairston College of Health and Human Sciences, North Carolina Agricultural and Technical State University, Greensboro, NC, USA.
⁹ School of Nursing, James Madison University, Harrisonburg, VA, USA.
¹⁰ Department of Environmental Health Sciences, College of Integrated Health Sciences, University at Albany, State University of New York, Rensselaer, NY, USA; Department of Population and Community Health, College of Public Health, The University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, USA. Electronic address: Kai.Zhang@unthsc.edu.

PMID: 40252492
DOI: 10.1016/j.scitotenv.2025.179376

Abstract

Background: Urbanization has increased impervious cover - surfaces that cannot absorb or filter water - which may raise cardiovascular disease (CVD) risks through reduced walkability, increased heat, and pollution. However, the relationship between imperviousness and subclinical CVD indicators, specifically carotid intima-media thickness (CIMT), remains unexplored, especially across diverse populations. This study aims to investigate whether impervious cover in residential communities is associated with CIMT, and whether these associations differ by race and sex.

Method: Linking urban impervious cover data from the National Land Cover Database (NLCD 2006) to individual carotid intima-media thickness (CIMT) information from the Coronary Artery Risk Development in Young Adults (CARDIA) study, this research employed linear regression models and examined whether the prevalence of impervious surface in immediate neighborhood and surrounding areas is associated with CIMT among middle-aged adults and whether the association varies across sex and race groups.

Results: Overall, there's no significant association between impervious coverage and CIMT, but differences exist among subpopulations. For women, the proportions of impervious surfaces within varying buffers (distance range 50 m to 5000 m) are positively associated with CIMT (β range 0.599 to 1.072 mm/m, with p range < 0.001 to 0.044), which can fully be annulled by a set of social determinants of health. Black adults' CIMT is still positively associated with impervious coverage beyond a buffer of 1 km regardless of the adjustment (β range 0.999 to 1.119 mm/m, with p range 0.024 to 0.043), while no significant association exists for buffers of 750 m or less. By comparison, there are no significant associations for men or White adults.

Conclusion: Our findings suggest that impervious cover in urban areas may contribute to early CVD development among Black adults. The absence of associations within smaller buffers and among other demographic groups highlights the complexity of environmental pathways and cardiovascular health.

Keywords: Built environment; Carotid intima-medial thickness (CIMT); Impervious cover; Race; Sex.

MeSH terms

Adult
Cardiovascular Diseases / epidemiology
Carotid Intima-Media Thickness* / statistics & numerical data
Coronary Artery Disease* / epidemiology
Female
Humans
Male
Middle Aged
Neighborhood Characteristics
Risk Factors
Urbanization
Young Adult