Perceived neighborhood environments and cardiovascular disease in older adults: the moderating role of cognitive activity.

Background and Objectives: Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality among older adults. While clinical risk factors are well documented, less is known about how perceived neighborhood environments interact with individual coping resources to influence CVD risk. Informed by the Stress Process Model and the Transactional Model of Stress and Coping, this study examines the associations between perceived neighborhood social cohesion and physical disorder and CVD among U.S. older adults, and whether cognitive activity moderates these associations. Research Design and Methods: Pooled data were drawn from the 2016 and 2018 waves of the Health and Retirement Study, including 6,249 adults aged 65 and older who completed the Leave-Behind Questionnaire. Perceived neighborhood social cohesion and physical disorder were measured using validated multi-item scales. Cognitive activity was assessed based on participation in five cognitively stimulating behaviors (e.g., reading, writing, playing word games). Survey-weighted logistic regressions were conducted to estimate associations between neighborhood characteristics and CVD, including interaction terms with cognitive activity. Results: Higher levels of social cohesion were associated with lower odds of CVD. Neither physical disorder nor cognitive activity was independently associated with CVD. However, cognitive activity moderated both neighborhood associations: the positive association between physical disorder and CVD was attenuated at higher levels of cognitive activity, whereas the protective association between social cohesion and CVD was weaker among individuals with greater cognitive activity. Discussion and Implications: Cognitive activity may buffer cardiovascular risk in physically disordered neighborhoods, while its benefits may be less apparent in socially cohesive settings. These findings suggest that cognitive engagement and neighborhood perceptions jointly shape cardiovascular risk and underscore the importance of integrated, multilevel interventions that promote both individual-level cognitive resources and neighborhood-level supports in aging populations.