Listen to Your Heart: The Risk of Spatial Environmental Factors on CVD-related and All-cause Mortality

Peter Gillespie ’25

Figure 1 Spatial environmental factors, such as an individual’s exposure to air pollution, may increase one’s risk of mortality.

Recent research from Dr. Paola Boffetta and his colleagues suggest that spatial and environmental factors around us can negatively affect our well-being. Dr. Boffetta and his team conducted a study that assesses how spatial environmental factors (SEF), or our proximity to both harmful or helpful environmental and social influences, affect both all-cause mortality and mortality due to cardiovascular disease (CVD). 

The study investigated eight SEFs that encapsulated one’s exposure to harmful, industrial constructs and access to helpful, preservative resources. The significance of these SEFs was observed in a population of over 50,000 participants in Iran. Most of the participants resided in rural households that might be vulnerable to these SEFs. To determine the risk of these SEFs, a multivariable survival model was conducted, in which the different spatial environmental factors were related to the risk of mortality. Dr. Boffetta and his team also performed chi-squared tests to assess the validity of the model and determine if the addition of another spatial environmental factor can improve the goodness-of-fit of the model beyond the typical risks. The population attribution fraction was also calculated, which analyzes the risk of mortality with the prevalence of the risk factor to determine how great of a risk any particular factor is to the entire population.

This analysis proposed several SEFs as a risk for both mortality of all causes and mortality specifically due to cardiovascular disease. Air pollution was shown to be a significant predictor of mortality for both outdoor exposure and indoor exposure. For instance, the use of fuels indoors without a chimney was a significant predictor of mortality both outdoor and indoor exposure. Additionally, those who lived farther from a percutaneous coronary intervention center, which focuses on opening clogged arteries, were at an increased risk of both all-cause mortality and morality from CVD as well. Living closer to traffic was also a predictor of mortality from CVD; however, this was not predictive of all-cause mortality. This correlation remained despite adjustments for ambient air pollution and socioeconomic condition, suggesting that there is an inherent quality of highways that may increase the risk of CVD-related mortality. 

This study simultaneously tested multiple SEFs at once, which further bolsters the validity of each SEF as there is mitigated risk of confounding influence from one SEF on another. While this study could not control for individuals who may have migrated from a different place, these findings may be helpful in designing policies and interventions specific to the environmental risk factors that pose a threat to particular populations. 

Works cited:

[1] M. Hadley, et al., Spatial environmental factors predict cardiovascular and all-cause mortality: results of the space study. PLoS ONE 17, 1-15 (2022). doi: 10.1371/journal.pone.0269650.

[2] Image retrieved from:


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