Spatial disparities in cardiovascular disease in Erie and Niagara Counties, New York State: The roles of the food environment, the built environment, income, and educational attainment

This thesis investigates the roles of the built environment, food environment, and regional and demographic factors in the incidence of cardiovascular disease in Western New York. The study uses a cross-sectional research design to answer the following questions: how do the built and food environments influence cardiovascular disease hospitalizations, and how do demographic and regional factors mediate those associations? The study corroborates others' findings that household income and the attainment of a bachelor's degree are strongly inversely associated with cardiovascular disease hospitalizations. Contrary to the findings of many other authors, however, the study shows that the density of convenience stores and fast food restaurants is negatively associated with cardiovascular hospitalizations, while intersection density is positively associated with hospitalizations. Additionally, this thesis found that regional factors and intersection density mediate the associations between cardiovascular disease hospitalizations, race, and household income. This study recommends that planners and policy makers, working alongside public health professionals, act to improve cardiovascular health in Western New York communities by playing the multiple roles our profession inspires, as: designers, educators, food system thinkers, strategists for community and economic development, and actors in the challenge to narrow educational, economic, and racial disparities.