Abstract
OBJECTIVE: To systematically investigate the association between neighborhood-level environmental burden and residents’ cardiovascular health in Tianjin, China. Additionally, it aimed to pinpoint neighborhoods confronting “environmental-social” dual disadvantages. The study intended to provide guidance for the equitable distribution of health resources and offer references for the formulation of public health strategies. METHODS: A cross-sectional design was employed in this study, which included 6,604,729 residents from 4407 neighborhoods in Tianjin. A neighborhood-level Environmental Burden Index (EBI) was constructed, covering the domains of air, built environment, and water. Meanwhile, the Social Vulnerability Index (SVI) was integrated to explore potential effect modification. Mixed-effects linear regression models were utilized to analyze the associations between EBI and the prevalence of cardiovascular diseases. Interaction terms were used to assess effect modification, and domain-specific associations were also examined. A spatial econometric model is employed to verify its robustness. RESULTS: The Social Vulnerability Index (SVI), unemployment rate, and uninsurance rate in neighborhoods with the highest environmental burden were all higher than those in neighborhoods with the lowest environmental burden (all P < 0.001). After adjusting for covariates, the Environmental Burden Index (EBI) remained positively correlated with the prevalence of the four types of diseases (all P < 0.001). In neighborhoods with high social vulnerability, the adverse impact of EBI on hypertension, diabetes, and stroke was stronger. The environmental burden in the air domain was associated with coronary heart disease and stroke, the built environment domain was associated with diabetes and coronary heart disease, and the water domain was associated with all four types of diseases. The results were verified to be robust by spatial econometric models. CONCLUSIONS: In Tianjin, neighborhood environmental burden is linked to poorer cardiovascular health, and social vulnerability exacerbates this impact for specific conditions. As such, targeted community-based interventions aimed at improving cardiovascular health should be put into practice. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-026-26473-7.