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Xu J, Jing Y, Xu X, Zhang X, Liu Y, He H, Chen F, Liu Y. Spatial scale analysis for the relationships between the built environment and cardiovascular disease based on multi-source data. Health Place 2023; 83:103048. [PMID: 37348293 DOI: 10.1016/j.healthplace.2023.103048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 05/12/2023] [Accepted: 05/19/2023] [Indexed: 06/24/2023]
Abstract
To examine what built environment characteristics improve the health outcomes of human beings is always a hot issue. While a growing literature has analyzed the link between the built environment and health, few studies have investigated this relationship across different spatial scales. In this study, eighteen variables were selected from multi-source data and reduced to eight built environment attributes using principal component analysis. These attributes included socioeconomic deprivation, urban density, street walkability, land-use diversity, blue-green space, transportation convenience, ageing, and street insecurity. Multiscale geographically weighted regression was then employed to clarify how these attributes relate to cardiovascular disease at different scales. The results indicated that: (1) multiscale geographically weighted regression showed a better fit of the association between the built environment and cardiovascular diseases than other models (e.g., ordinary least squares and geographically weighted regression), and is thus an effective approach for multiscale analysis of the built environment and health associations; (2) built environment variables related to cardiovascular diseases can be divided into global variables with large scales (e.g., socioeconomic deprivation, street walkability, land-use diversity, blue-green space, transportation convenience, and ageing) and local variables with small scales (e.g., urban density and street insecurity); and (3) at specific spatial scales, global variables had trivial spatial variation across the area, while local variables showed significant gradients. These findings provide greater insight into the association between the built environment and lifestyle-related diseases in densely populated cities, emphasizing the significance of hierarchical and place-specific policy formation in health interventions.
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Affiliation(s)
- Jiwei Xu
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, 430079, PR China
| | - Ying Jing
- Business School, Ningbo Institute of Technology, Zhejiang University, Ningbo, 315100, PR China
| | - Xinkun Xu
- Fujian Provincial Expressway Information Technology Company Limited, Fuzhou, 350000, PR China
| | - Xinyi Zhang
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, 430079, PR China
| | - Yanfang Liu
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, 430079, PR China; Key Laboratory of Geographic Information System of Ministry of Education, Wuhan University, Wuhan, 430079, PR China; Collaborative Innovation Center of Geospatial Technology, Wuhan University, Wuhan, 430079, PR China
| | - Huagui He
- Guangzhou Urban Planning & Design Survey Research Institute, Guangzhou, 510060, PR China
| | - Fei Chen
- Guangzhou Urban Planning & Design Survey Research Institute, Guangzhou, 510060, PR China
| | - Yaolin Liu
- School of Resource and Environmental Sciences, Wuhan University, Wuhan, 430079, PR China; Key Laboratory of Geographic Information System of Ministry of Education, Wuhan University, Wuhan, 430079, PR China; Collaborative Innovation Center of Geospatial Technology, Wuhan University, Wuhan, 430079, PR China.
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Selvakumaran S, Lin CY, Hadgraft N, Chandrabose M, Owen N, Sugiyama T. Area-level socioeconomic inequalities in overweight and obesity: Systematic review on moderation by built-environment attributes. Health Place 2023; 83:103101. [PMID: 37625238 DOI: 10.1016/j.healthplace.2023.103101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/03/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023]
Abstract
Residents of lower socioeconomic status (SES) areas are at a higher risk of overweight/obesity than those from higher SES areas. Built environment attributes may mitigate such inequalities. This systematic review synthesised findings of studies examining built environment attributes as potential moderators of the associations between area-level SES and overweight/obesity in adults. From five databases, nine eligible studies were identified. The SES-overweight/obesity relationship was stronger in inner areas and suburbs of large cities, while it was weaker in more rural areas. Two studies examined walkability and reported contrasting findings: no moderation in one and marginally significant moderation (less inequality in higher walkability areas) in the other. No evidence of moderation was found for street connectivity, population density, the food environment, access to physical activity facilities and several perceived environmental attributes. Further research is needed on other built environment attributes (e.g., access to, quantity and quality of green spaces, active transport features), and ideally using prospective study designs and objective makers of adiposity.
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Affiliation(s)
- Sungkavi Selvakumaran
- Centre for Urban Transitions, Swinburne University of Technology, Level 1 EW Building, Hawthorn, VIC, 3122, Australia.
| | - Chien-Yu Lin
- Centre for Urban Transitions, Swinburne University of Technology, Level 1 EW Building, Hawthorn, VIC, 3122, Australia; Department of Public Health, College of Public Health, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist., Taichung, 406040, Taiwan; Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa City, Saitama, 359-1192, Japan.
| | - Nyssa Hadgraft
- Centre for Urban Transitions, Swinburne University of Technology, Level 1 EW Building, Hawthorn, VIC, 3122, Australia; Baker Heart & Diabetes Institute, 75 Commercial Rd, Melbourne, VIC, 3004, Australia.
| | - Manoj Chandrabose
- Centre for Urban Transitions, Swinburne University of Technology, Level 1 EW Building, Hawthorn, VIC, 3122, Australia; Baker Heart & Diabetes Institute, 75 Commercial Rd, Melbourne, VIC, 3004, Australia.
| | - Neville Owen
- Centre for Urban Transitions, Swinburne University of Technology, Level 1 EW Building, Hawthorn, VIC, 3122, Australia; Baker Heart & Diabetes Institute, 75 Commercial Rd, Melbourne, VIC, 3004, Australia.
| | - Takemi Sugiyama
- Centre for Urban Transitions, Swinburne University of Technology, Level 1 EW Building, Hawthorn, VIC, 3122, Australia; Baker Heart & Diabetes Institute, 75 Commercial Rd, Melbourne, VIC, 3004, Australia.
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Coorey CP, Knibbs LD, Otton J. Social, Geographical and Income Inequality as Demonstrated by the Coronary Calcium Score: An Ecological Study in Sydney, Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095699. [PMID: 37174216 PMCID: PMC10178035 DOI: 10.3390/ijerph20095699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/06/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND The coronary calcium score is a non-invasive biomarker of coronary artery disease. The concept of "arterial age" transforms the coronary calcium score to an expected age based on the degree of coronary atherosclerosis. This study aimed to investigate the relationship of socioeconomic status with the burden of coronary artery disease within Sydney, Australia. METHODS This was an ecological study at the postcode level of patients aged 45 and above who had completed a CT coronary calcium scan within New South Wales (NSW), Australia from January 2012 to December 2020. Arterial age difference was calculated as arterial age minus chronological age. Socioeconomic data was obtained for median income, Index of Relative Socio-economic Advantage and Disadvantage (IRSAD) score and median property price. Linear regression was used for analysis. RESULTS There were 17,102 patients across 325 postcodes within NSW, comprising 9129 males with a median arterial age difference of 7 years and 7972 females with -9 years. Income, IRSAD score and property price each had an inverse relationship with arterial age difference (p-values < 0.05). CONCLUSIONS Income, socioeconomic status and local property prices are significantly correlated with premature coronary aging. Healthcare resource allocation and prevention should target the inequalities identified to reduce the burden of coronary artery disease.
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Affiliation(s)
- Craig Peter Coorey
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
- Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia
| | - Luke D Knibbs
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Camperdown, Sydney, NSW 2050, Australia
- Public Health Research Analytics and Methods for Evidence, Public Health Unit, Sydney Local Health District, Camperdown, Sydney, NSW 2050, Australia
| | - James Otton
- Department of Cardiology, Liverpool Hospital, Liverpool, NSW 2170, Australia
- Faculty of Medicine, South Western Sydney Clinical School, UNSW, Sydney, NSW 2170, Australia
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Carroll SJ, Dale MJ, Turrell G. Neighbourhood socioeconomic disadvantage and body size in Australia's capital cities: The contribution of obesogenic environments. PLoS One 2023; 18:e0280223. [PMID: 36662685 PMCID: PMC9858776 DOI: 10.1371/journal.pone.0280223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 12/26/2022] [Indexed: 01/21/2023] Open
Abstract
Residents of socioeconomically disadvantaged neighbourhoods have higher rates of overweight and obesity and chronic disease than their counterparts from advantaged neighbourhoods. This study assessed whether associations between neighbourhood disadvantage and measured body mass index (BMI) and waist circumference, are accounted for by obesogenic environments (i.e., residential distance to the Central Business District [CBD], supermarket availability, access to walkable destinations). The study used 2017-18 National Health Survey data for working-aged adults (aged ≥18 years, n = 9,367) residing in 3,454 neighbourhoods across Australia's state and territory capital cities. In five of eight cities (i.e., Sydney, Melbourne, Brisbane, Adelaide, and Perth) residents of disadvantaged neighbourhoods had significantly higher BMI and a larger waist circumference than residents of more advantaged areas. There was no association between neighbourhood disadvantage and body size in Hobart, Darwin, and Canberra. Associations between neighbourhood disadvantage and body size were partially explained by neighbourhood differences in distance to the CBD but not supermarket availability or walkable amenities. The results of this study point to the role of urban design and city planning as mechanisms for addressing social and economic inequities in Australia's capital cities, and as solutions to this country's overweight and obesity epidemic and associated rising rates of chronic disease.
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Affiliation(s)
- Suzanne J. Carroll
- Australian Geospatial Health Laboratory, Health Research Institute, University of Canberra, Canberra, Australian Capital City, Australia
| | - Michael J. Dale
- Australian Geospatial Health Laboratory, Health Research Institute, University of Canberra, Canberra, Australian Capital City, Australia
| | - Gavin Turrell
- Australian Geospatial Health Laboratory, Health Research Institute, University of Canberra, Canberra, Australian Capital City, Australia
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Collins D, Lee H, Dunbar MD, Crowder K. Associations between Neighborhood Disadvantage and Dog Walking among Participants in the Dog Aging Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11179. [PMID: 36141449 PMCID: PMC9517596 DOI: 10.3390/ijerph191811179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/03/2022] [Accepted: 09/03/2022] [Indexed: 06/16/2023]
Abstract
Although neighborhood socioeconomic disadvantage is negatively related to overall physical activity, prior studies reveal a complex relationship between disadvantage and particular walking behaviors. While disadvantage is associated with reduced recreational walking through a hypothesized "fear-of-crime" mechanism, the built environment in disadvantaged neighborhoods may encourage utilitarian walking. To date, no study has assessed how disadvantage relates to dog walking, a distinct walking behavior that is neither strictly recreational nor utilitarian but represents a key mechanism through which pet ownership may affect human health. We employ a large (n = 19,732) dataset from the Dog Aging Project to understand how neighborhood disadvantage is associated with dog walking when controlling for individual-, household-, and environmental-level factors. We find that dog owners in more disadvantaged neighborhoods report less on-leash walking activity compared to owners in advantaged neighborhoods and discuss the possibility of a fear-of-crime mechanism underlying this association. These findings improve our understanding of the relationship between neighborhood disadvantage and physical function and highlight the need for public health interventions that encourage dog ownership to consider neighborhood disadvantage.
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Affiliation(s)
- Devin Collins
- Department of Sociology, University of Washington, Seattle, WA 98195, USA
| | - Hannah Lee
- Department of Sociology, University of Washington, Seattle, WA 98195, USA
| | - Matthew D Dunbar
- Center for Studies in Demography and Ecology, Seattle, WA 98195, USA
| | - Kyle Crowder
- Department of Sociology, University of Washington, Seattle, WA 98195, USA
- Center for Studies in Demography and Ecology, Seattle, WA 98195, USA
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Lifestyle factors as mediators of area-level socio-economic differentials in cardiovascular disease risk factors. The Tromsø Study. SSM Popul Health 2022; 19:101241. [PMID: 36203474 PMCID: PMC9530956 DOI: 10.1016/j.ssmph.2022.101241] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/15/2022] [Accepted: 09/23/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Cardiovascular disease (CVD) is a leading cause of death and disability and living in areas with low socio-economic status (SES) is associated with increased risk of CVD. Lifestyle factors such as smoking, physical inactivity, an unhealthy diet and harmful alcohol use are main risk factors that contribute to other modifiable risk factors, such as hypertension, raised blood cholesterol, obesity, and diabetes. The potential impact of area-level socio-economic status (ASES) on metabolic CVD risk factors via lifestyle behaviors independent of individual SES has not been investigated previously. Aims To estimate associations of ASES with CVD risk factors and the mediating role of lifestyle behaviors independent of individual-level SES. Methods In this cross-sectional study, we included 19,415 participants (52% women) from the seventh survey of the Tromsø Study (2015–2016) (Tromsø7). The exposure variable ASES was created by aggregating individual-level SES variables (education, income, housing ownership) at the geographical subdivision level. Individual-level SES data and geographical subdivision of Tromsø municipality (36 areas) were obtained from Statistics Norway. Variables from questionnaires and clinical examinations obtained from Tromsø7 were used as mediators (smoking, snuff, alcohol, and physical activity), while the outcome variables were body mass index (BMI), total/high-density lipoprotein (HDL) cholesterol ratio, waist circumference, hypertension, diabetes. Mediation and mediated moderation analysis were performed with age as a moderator, stratified by sex. Results ASES was significantly associated with all outcome variables. CVD risk factor level declined with an increase in ASES. These associations were mediated by differences in smoking habits, alcohol use and physical activity. The associations of ASES with total/HDL cholesterol ratio and waist circumference (women) were moderated by age, and the moderating effects were mediated by smoking and physical activity in both sexes. The largest mediated effects were seen in the associations of ASES with total/HDL cholesterol ratio, with the mediators accounting for 43% of the observed effects. Conclusions Living in lower SES areas is associated with increased CVD risk due to unhealthy lifestyle behaviors, such as smoking, alcohol use and physical inactivity. These associations were stronger in women and among older participants.
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D'Agostino EM, Armstrong SC, Alexander EP, Østbye T, Neshteruk CD, Skinner AC. Predictors and Patterns of Physical Activity From Transportation Among United States Youth, 2007-2016. J Adolesc Health 2021; 69:263-271. [PMID: 33958267 DOI: 10.1016/j.jadohealth.2021.03.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/17/2021] [Accepted: 03/31/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE Physical activity is strongly associated with health benefits in youth, although wide disparities in physical activity persist across sex, race/ethnicity, and income. Active transportation is an important source of youth physical activity. We aimed to describe active transportation patterns for United States adolescents and young adults ages 12-25 years across sociodemographic and weight status characteristics. METHODS Cross-sectional secondary data analyses were based on self-reported transportation-related physical activity using the National Health and Nutrition Examination Survey, 2007-2016. RESULTS Of the sample (n = 8,680; population represented, N = 57,768,628), 4,300 (49.5%) were adolescents (12-17 y), and 4,380 (50.4%) were young adults (18-25 y). Male adolescents were more likely to participate in any (risk ratio [RR] = 1.3; 95% confidence interval [CI], 1.16-1.40) and daily (RR = 1.3; 95% CI, 1.06-1.63) active transportation than females. Black (RR = 1.1; 95% CI, 1.01-1.31) and Hispanic (RR = 1.2; 95% CI, 1.05-1.31) adolescents were more likely to engage in any active transportation than whites. Young adult males were more likely to participate in any (RR = 1.3; 95% CI, 1.20-1.50) and daily (RR = 1.3; 95% CI, 1.08-1.55) active transportation than females. Young adults with a lower family income, and both adolescents and young adults with a lower household education, were more likely to engage in any and daily active transportation. We also observed an inverse relationship between weight class and active transportation participation. CONCLUSION Active transportation was higher in males, minority, and lower income youth. Our study findings provide evidence for physical activity interventions, suggesting active transportation is a feasible target for low-income and minority youth to reduce physical activity disparities and support optimal health.
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Affiliation(s)
- Emily M D'Agostino
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina.
| | - Sarah C Armstrong
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina; Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Emily P Alexander
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Truls Østbye
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina; Duke Global Health Institute, Duke University School of Medicine, Durham, North Carolina
| | - Cody D Neshteruk
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Asheley C Skinner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
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