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Article(id=1240972424376799662, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240972413354176744, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202312457, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1703433600000, receivedDateStr=2023-12-25, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773800482124, onlineDateStr=2026-03-18, pubDate=1715270400000, pubDateStr=2024-05-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773800482124, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773800482124, creator=13701087609, updateTime=1773800482124, updator=13701087609, issue=Issue{id=1240972413354176744, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='9', pageStart='1537', pageEnd='1728', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773800479495, creator=13701087609, updateTime=1773800596829, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240972905568334240, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240972413354176744, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240972905568334241, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240972413354176744, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1586, endPage=1590, ext={EN=ArticleExt(id=1240972424699761099, articleId=1240972424376799662, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Study on the influence of built environmental factors on cardiovascular diseases in middle-aged and elderly people, columnId=1228016570660745413, journalTitle=Modern Preventive Medicine, columnName=Environmental and Occupational Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the effect of built environment on cardiovascular disease in middle-aged and elderly people.

Methods

In this study, 17 256 subjects were selected from China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018, and the built environment and meteorological data of their cities were collected. Multivariate logistics regression model and weighted quantile regression model were used to analyze the relationship between built environment and cardiovascular disease in the middle-aged and elderly.

Results

Multivariate logistics regression analysis showed that for every increase of interquartile range (IQR) in land use mixture, residential land, and industrial land, the OR values were 1.13(95%CI: 1.07-1.19), 1.16 (95%CI: 1.10-1.23), and 1.11 (95%CI: 1.06-1.16), respectively. When the proportion of commercial land and green space area increased by 1 IQR, the OR values (95%CI) were 0.88 (95%CI: 0.85-0.92) and 0.94 (95%CI: 0.90-0.98), respectively. The mixed degree of land use, the proportion of residential land, and the proportion of industrial land all increased the risk of cardiovascular disease in men and women (P < 0.05), while the proportion of commercial land decreased the risk of cardiovascular disease in men and women. The green space area only decreased the risk of cardiovascular disease in women (P < 0.05). In the mixed exposure of 8 kinds of built environmental factors, the proportion of industrial land and residential land were 34.13% and 29.20%, respectively.

Conclusion

The built environment has a significant impact on the risk of cardiovascular disease in the middle-aged and elderly, and the area of green space has a more significant effect on the cardiovascular disease in the middle-aged and elderly women.

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目的

探讨建成环境对中老年人群心血管疾病的影响。

方法

选择2011—2018年中国健康与养老追踪调查数据中17 256名研究对象，并收集其所在城市的建成环境及气象相关数据。运用多因素logistic回归模型和加权分位数回归模型分析建成环境与中老年人心血管疾病的关联。

结果

多因素logistic回归分析显示，土地利用混合度、居住用地占比、工业用地占比每增加1个IQR，OR值分别为1.13（95%CI：1.07～1.19）、1.16（95%CI：1.10～1.23）、1.11（95%CI：1.06～1.16）；商业用地占比和绿地面积每增加1个IQR，OR值分别为0.88（95%CI：0.85～0.92）、0.94（95%CI：0.90～0.98）。土地利用混合度、居住用地占比、工业用地占比均增加男性和女性心血管患病风险（P<0.05），商业用地占比均降低男性和女性心血管患病风险。绿地面积仅降低女性心血管患病风险（P<0.05）。八种建成环境因素混合暴露中工业用地占比和居住用地占比权重较大，分别为34.13%和29.20%。

结论

建成环境对中老年人心血管疾病患病风险具有显著影响，并且绿地面积对女性中老年人心血管疾病患病影响更为显著。

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董少霞，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=nlXW80hJzbCBf0s1Clzmfw==, magXml=ixdx1L3qU+BaX136n46PCA==, pdfUrl=null, pdf=iejN5S6aJsSGqfhihJAfug==, pdfFileSize=740132, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=wM6Y2nw3IDvdnumHhyupaQ==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=i3N+tfpTh7elP0+J9hZbhg==, mapNumber=null, authorCompany=null, fund=null, authors=

史珏鑫（1998—），女，硕士在读，研究方向：环境流行病学

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Impact of community green spaces on cardiovascular health: a case study of Chang′an District, Xi′an city[J]. Landscape Architecture, 2023, 30(12): 33-39., articleTitle=Impact of community green spaces on cardiovascular health: a case study of Chang′an District, Xi′an city, refAbstract=null), Reference(id=1240986272580292939, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972424376799662, doi=null, pmid=null, pmcid=null, year=2022, volume=158, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[16], rfOrder=22, authorNames=Lai KY, Kumari S, Gallacher J, journalName=Environment International, refType=null, unstructuredReference=Lai KY, Kumari S, Gallacher J, et al. Associations of residential walkability and greenness with arterial stiffness in the UK Biobank[J]. Environment International, 2022, 158: 106960., articleTitle=Associations of residential walkability and greenness with arterial stiffness in the UK Biobank, refAbstract=null), Reference(id=1240986273062637905, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972424376799662, doi=null, pmid=null, pmcid=null, year=2023, volume=34, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[17], rfOrder=23, authorNames=Lozano P, Randal FT, Peters A, journalName=Preventive Medicine Reports, refType=null, unstructuredReference=Lozano P, Randal FT, Peters A, et al. The impact of neighborhood disadvantage on colorectal cancer screening among African Americans in Chicago[J]. Preventive Medicine Reports, 2023, 34: 102235., articleTitle=The impact of neighborhood disadvantage on colorectal cancer screening among African Americans in Chicago, refAbstract=null), Reference(id=1240986273263964502, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972424376799662, doi=null, pmid=null, pmcid=null, year=2020, volume=17, issue=23, pageStart=8805, pageEnd=null, url=null, language=null, rfNumber=[18], rfOrder=24, authorNames=Yitshak-Sade M, Fabian MP, Lane KJ, journalName=International Journal of Environmental Research and Public Health, refType=null, unstructuredReference=Yitshak-Sade M, Fabian MP, Lane KJ, et al. Estimating the combined effects of natural and built environmental exposures on birthweight among urban residents in Massachusetts[J]. International Journal of Environmental Research and Public Health, 2020, 17(23):8805., articleTitle=Estimating the combined effects of natural and built environmental exposures on birthweight among urban residents in Massachusetts, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1240986261679297386, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972424376799662, xref=null, ext=[AuthorCompanyExt(id=1240986261704463211, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972424376799662, companyId=1240986261679297386, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China), AuthorCompanyExt(id=1240986261721240429, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972424376799662, companyId=1240986261679297386, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=中国疾病预防控制中心环境与健康相关产品安全所，北京 100021)])], figs=[ArticleFig(id=1240986264866967579, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972424376799662, language=EN, label=Figure 1, caption=Spearman rank correlation coefficient matrix of 8 built environment factors, figureFileSmall=i4m8b4vp0gJ8hM/a+vyJ2w==, figureFileBig=mHvGfe7MS/ZWEihZg3UqPg==, tableContent=null), ArticleFig(id=1240986265080877094, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972424376799662, language=CN, label=图1, caption=八种建成环境和气象因素的Spearman秩相关系数矩阵图

注：空白方格表示因素间Spearman秩相关检验没有统计学意义，黑色数字为秩相关系数。

, figureFileSmall=i4m8b4vp0gJ8hM/a+vyJ2w==, figureFileBig=mHvGfe7MS/ZWEihZg3UqPg==, tableContent=null), ArticleFig(id=1240986265257037880, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972424376799662, language=EN, label=Figure 2, caption=Effects of mixed exposure of 8 built environment on cardiovascular diseases in middle-aged and elderly people in WQS regression model, figureFileSmall=ZppiNv0AwkVXqwPZgLAxog==, figureFileBig=jrlWw3GGBnjVyDAuWrhXKw==, tableContent=null), ArticleFig(id=1240986265508696134, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972424376799662, language=CN, label=图2, caption=WQS回归模型中八种建成环境混合暴露对中老年人心血管疾病影响, figureFileSmall=ZppiNv0AwkVXqwPZgLAxog==, figureFileBig=jrlWw3GGBnjVyDAuWrhXKw==, tableContent=null), ArticleFig(id=1240986265777131600, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972424376799662, language=EN, label=Table 1, caption=

Basic characteristics of middle-aged and elderly people in CHARLS, 2011—2018 ［M（P25，P75），n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量对照组 (n=13 869)病例组 (n=3 387)P值
年龄（岁）60.0 (53.0,67.0)65.0 (57.0,71.0)<0.001
性别
男6 890 (49.7)1 330 (39.3)<0.001
女6 979 (50.3)2 057 (60.7)
教育水平
小学以下5 320 (38.4)1 345 (39.7)<0.001
小学和初中7 035 (50.7)1 581 (46.7)
高中及以上1 514 (10.9)461 (13.6)
婚姻状态
已婚12 052 (86.9)2 812 (83.0)<0.001
其他1 817 (13.1)575 (17.0)
重体力活动
是4 831 (34.9)756 (22.3)<0.001
否9 030 (65.1)2 628 (77.7)
中体力活动
是7 064 (51.0)1 556 (46.0)<0.001
否6 797 (49.0)1 828 (54.0)
轻体力活动
是11 594 (83.6)2 790 (82.4)0.100
否2 267 (16.4)594 (17.6)
饮酒
是6 819 (49.2)1 415 (41.8)<0.001
否7 047 (50.8)1 971 (58.2)
吸烟
是6 008 (43.3)1 355 (40.0)<0.001
否7 853 (56.7)2 029 (60.0)
), ArticleFig(id=1240986266024595551, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972424376799662, language=CN, label=表1, caption=

2011—2018年CHARLS中老年人群基本特征［M（P25，P75），n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量对照组 (n=13 869)病例组 (n=3 387)P值
年龄（岁）60.0 (53.0,67.0)65.0 (57.0,71.0)<0.001
性别
男6 890 (49.7)1 330 (39.3)<0.001
女6 979 (50.3)2 057 (60.7)
教育水平
小学以下5 320 (38.4)1 345 (39.7)<0.001
小学和初中7 035 (50.7)1 581 (46.7)
高中及以上1 514 (10.9)461 (13.6)
婚姻状态
已婚12 052 (86.9)2 812 (83.0)<0.001
其他1 817 (13.1)575 (17.0)
重体力活动
是4 831 (34.9)756 (22.3)<0.001
否9 030 (65.1)2 628 (77.7)
中体力活动
是7 064 (51.0)1 556 (46.0)<0.001
否6 797 (49.0)1 828 (54.0)
轻体力活动
是11 594 (83.6)2 790 (82.4)0.100
否2 267 (16.4)594 (17.6)
饮酒
是6 819 (49.2)1 415 (41.8)<0.001
否7 047 (50.8)1 971 (58.2)
吸烟
是6 008 (43.3)1 355 (40.0)<0.001
否7 853 (56.7)2 029 (60.0)
), ArticleFig(id=1240986266196562031, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972424376799662, language=EN, label=Table 2, caption=

Logistic regression analysis results of the relationship between built environment and cardiovascular diseases in middle-aged and elderly people

, figureFileSmall=null, figureFileBig=null, tableContent=
暴露模型1模型2模型3
OR值(95%CI)P值OR值(95%CI)P值OR值(95%CI)P值
人口密度（人/ km2）0.96 (0.90～1.02)0.181.09(1.02～1.17)0.960.94 (0.89～1.01)0.08
土地利用混合度1.15 (1.09～1.21)< 0.0011.12(1.05～1.20)0.011.13 (1.07～1.19)< 0.001
居住用地占比（%）1.16 (1.10～1.23)< 0.0011.22(1.14～1.32)< 0.0011.16 (1.10～1.23)< 0.001
工业用地占比（%）1.12 (1.07～1.17)< 0.0011.14(1.08～1.21)< 0.0011.11 (1.06～1.16)< 0.001
商业用地占比（%）0.90 (0.87～0.94)< 0.0010.88(0.83～0.92)< 0.0010.88 (0.85～0.92)< 0.001
绿地面积（km2）0.97 (0.94～1.01)0.170.87(0.83～0.92)< 0.0010.94 (0.90～0.98)0.00
道路密度（km/km2）1.02 (0.95～1.09)0.670.85(0.78～0.93)< 0.0011.04 (0.96～1.11)0.34
道路面积率（%）1.04 (0.96～1.12)0.361.04(0.95～1.13)0.401.02 (0.94～1.11)0.62
AIC16 45916 21015 684
McFadden伪R20.040.050.08
似然比检验—< 0.001a< 0.001b
), ArticleFig(id=1240986266460803189, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972424376799662, language=CN, label=表2, caption=

建成环境与中老年人心血管病患病关联的logistic回归分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
暴露模型1模型2模型3
OR值(95%CI)P值OR值(95%CI)P值OR值(95%CI)P值
人口密度（人/ km2）0.96 (0.90～1.02)0.181.09(1.02～1.17)0.960.94 (0.89～1.01)0.08
土地利用混合度1.15 (1.09～1.21)< 0.0011.12(1.05～1.20)0.011.13 (1.07～1.19)< 0.001
居住用地占比（%）1.16 (1.10～1.23)< 0.0011.22(1.14～1.32)< 0.0011.16 (1.10～1.23)< 0.001
工业用地占比（%）1.12 (1.07～1.17)< 0.0011.14(1.08～1.21)< 0.0011.11 (1.06～1.16)< 0.001
商业用地占比（%）0.90 (0.87～0.94)< 0.0010.88(0.83～0.92)< 0.0010.88 (0.85～0.92)< 0.001
绿地面积（km2）0.97 (0.94～1.01)0.170.87(0.83～0.92)< 0.0010.94 (0.90～0.98)0.00
道路密度（km/km2）1.02 (0.95～1.09)0.670.85(0.78～0.93)< 0.0011.04 (0.96～1.11)0.34
道路面积率（%）1.04 (0.96～1.12)0.361.04(0.95～1.13)0.401.02 (0.94～1.11)0.62
AIC16 45916 21015 684
McFadden伪R20.040.050.08
似然比检验—< 0.001a< 0.001b
), ArticleFig(id=1240986266683101311, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972424376799662, language=EN, label=Table 3, caption=

Logistic regression analysis results of the built environment and cardiovascular diseases in middle-aged and elderly people of different genders

, figureFileSmall=null, figureFileBig=null, tableContent=
暴露男性女性
OR值(95%CI)P值OR值(95%CI)P值
人口密度（人/ km2）0.93(0.84～1.03)0.160.95(0.87～1.03)0.23
土地利用混合度1.09(1.00～1.19)0.041.16(1.07～1.25)< 0.001
居住用地占比（%）1.09(1.01～1.19)0.031.21(1.13～1.30)< 0.001
工业用地占比（%）1.09(1.01～1.17)0.031.12(1.05～1.19)< 0.001
商业用地占比（%）0.91(0.85～0.97)0.000.87(0.83～0.92)< 0.001
绿地面积（km2）0.96(0.91～1.02)0.220.93(0.88～0.98)0.00
道路密度（km/km2）1.01(0.90～1.13)0.861.05(0.95～1.15)0.34
道路面积率（%）1.11(0.98～1.26)0.100.97(0.87～1.08)0.59
AIC6 7718 885
McFadden伪R20.080.09
), ArticleFig(id=1240986266892816515, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240972424376799662, language=CN, label=表3, caption=

建成环境与不同性别中老年人心血管病的logistic回归分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
暴露男性女性
OR值(95%CI)P值OR值(95%CI)P值
人口密度（人/ km2）0.93(0.84～1.03)0.160.95(0.87～1.03)0.23
土地利用混合度1.09(1.00～1.19)0.041.16(1.07～1.25)< 0.001
居住用地占比（%）1.09(1.01～1.19)0.031.21(1.13～1.30)< 0.001
工业用地占比（%）1.09(1.01～1.17)0.031.12(1.05～1.19)< 0.001
商业用地占比（%）0.91(0.85～0.97)0.000.87(0.83～0.92)< 0.001
绿地面积（km2）0.96(0.91～1.02)0.220.93(0.88～0.98)0.00
道路密度（km/km2）1.01(0.90～1.13)0.861.05(0.95～1.15)0.34
道路面积率（%）1.11(0.98～1.26)0.100.97(0.87～1.08)0.59
AIC6 7718 885
McFadden伪R20.080.09
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建成环境因素对中老年人群心血管疾病的影响研究
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史珏鑫 , 董少霞
现代预防医学 | 环境与职业卫生 2024,51(9): 1586-1590
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现代预防医学 | 环境与职业卫生 2024, 51(9): 1586-1590
建成环境因素对中老年人群心血管疾病的影响研究
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史珏鑫, 董少霞
作者信息
  • 中国疾病预防控制中心环境与健康相关产品安全所，北京 100021

    • 史珏鑫（1998—），女，硕士在读，研究方向：环境流行病学

通讯作者:

董少霞，E-mail:
Study on the influence of built environmental factors on cardiovascular diseases in middle-aged and elderly people
Jue-xin SHI, Shao-xia DONG
Affiliations
  • National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
出版时间: 2024-05-10 doi: 10.20043/j.cnki.MPM.202312457
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摘要
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目的

探讨建成环境对中老年人群心血管疾病的影响。

方法

选择2011—2018年中国健康与养老追踪调查数据中17 256名研究对象，并收集其所在城市的建成环境及气象相关数据。运用多因素logistic回归模型和加权分位数回归模型分析建成环境与中老年人心血管疾病的关联。

结果

多因素logistic回归分析显示，土地利用混合度、居住用地占比、工业用地占比每增加1个IQR，OR值分别为1.13（95%CI：1.07～1.19）、1.16（95%CI：1.10～1.23）、1.11（95%CI：1.06～1.16）；商业用地占比和绿地面积每增加1个IQR，OR值分别为0.88（95%CI：0.85～0.92）、0.94（95%CI：0.90～0.98）。土地利用混合度、居住用地占比、工业用地占比均增加男性和女性心血管患病风险（P<0.05），商业用地占比均降低男性和女性心血管患病风险。绿地面积仅降低女性心血管患病风险（P<0.05）。八种建成环境因素混合暴露中工业用地占比和居住用地占比权重较大，分别为34.13%和29.20%。

结论

建成环境对中老年人心血管疾病患病风险具有显著影响，并且绿地面积对女性中老年人心血管疾病患病影响更为显著。

建成环境  /  心血管疾病  /  混合暴露
Objective

To investigate the effect of built environment on cardiovascular disease in middle-aged and elderly people.

Methods

In this study, 17 256 subjects were selected from China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018, and the built environment and meteorological data of their cities were collected. Multivariate logistics regression model and weighted quantile regression model were used to analyze the relationship between built environment and cardiovascular disease in the middle-aged and elderly.

Results

Multivariate logistics regression analysis showed that for every increase of interquartile range (IQR) in land use mixture, residential land, and industrial land, the OR values were 1.13(95%CI: 1.07-1.19), 1.16 (95%CI: 1.10-1.23), and 1.11 (95%CI: 1.06-1.16), respectively. When the proportion of commercial land and green space area increased by 1 IQR, the OR values (95%CI) were 0.88 (95%CI: 0.85-0.92) and 0.94 (95%CI: 0.90-0.98), respectively. The mixed degree of land use, the proportion of residential land, and the proportion of industrial land all increased the risk of cardiovascular disease in men and women (P < 0.05), while the proportion of commercial land decreased the risk of cardiovascular disease in men and women. The green space area only decreased the risk of cardiovascular disease in women (P < 0.05). In the mixed exposure of 8 kinds of built environmental factors, the proportion of industrial land and residential land were 34.13% and 29.20%, respectively.

Conclusion

The built environment has a significant impact on the risk of cardiovascular disease in the middle-aged and elderly, and the area of green space has a more significant effect on the cardiovascular disease in the middle-aged and elderly women.

Built environment  /  Cardiovascular disease  /  Mixed exposure
史珏鑫, 董少霞. 建成环境因素对中老年人群心血管疾病的影响研究. 现代预防医学, 2024 , 51 (9) : 1586 -1590 . DOI: 10.20043/j.cnki.MPM.202312457
Jue-xin SHI, Shao-xia DONG. Study on the influence of built environmental factors on cardiovascular diseases in middle-aged and elderly people[J]. Modern Preventive Medicine, 2024 , 51 (9) : 1586 -1590 . DOI: 10.20043/j.cnki.MPM.202312457
正文
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随着老龄化加剧、社会经济发展和人民生活水平提高，心血管疾病等慢性疾病逐渐成为威胁人类健康的主要原因。根据全球心血管疾病负担报告显示，1990—2019年心血管病的病例几乎翻了一番，全球心血管患病人数从2.71亿增加到5.23亿，心血管病死亡人数从1 210万增长到1 860万[1]。2019我国年农村、城市心血管病分别占死因的46.74%和44.26%。每5例死亡中就有2例死于心血管疾病[2]。建成环境指人类为了更好的生活和适应社会发展而建立的人工设施，如住房、学校、社区、企业单位、休闲旅游建设等物质系统[3]。良好的建成环境有助于改善居民的健康状况，提高身体活动水平，进而降低肥胖、糖尿病、高血压等疾病的发生风险[4-5]。然而基于建成环境对中老年人群心血管疾病的流行病学研究目前相对缺乏。此外不适宜的气象条件也可能会影响脑卒中、代谢综合征等疾病的发生发展[6-7]，但校正气象条件下，建成环境及其混合物与心血管疾病的相关研究也鲜有报道。因此本研究基于2011—2018年中国健康与养老追踪调查，分析八种建成环境对中老年人群心血管疾病的关系。
1　资料与方法
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1.1　数据来源
研究对象数据来源于2011—2018年中国健康与养老追踪调查（China Health and Retirement Longitudinal Study，CHARLS）。CHARLS在全国28个省（自治区、直辖市），150个县级单位，450个村级单位进行PPS随机抽样，通过入户面对面的方式对45岁以上中老年人家庭进行调查。调查内容包括基本信息、家庭信息、健康状况与功能等，具有较高的研究价值。本研究根据研究目的共筛选出18 661个样本，排除数据缺失等，共纳入17 256个样本，样本有效率为92.4%。
建成环境资料来源于《中国城市建设统计年鉴》（2018年），主要收集各个城市的人口密度、土地利用程度、居住用地面积、工业用地面积、商业用地面积、城市建设用地面积、绿地面积、道路长度、道路面积和城区面积。城市气象资料来源于中国地面气候资料日值数据集（V3.0）。
1.2　研究变量及定义
根据研究目的整理45岁以上中老年人基本信息和心血管疾病患病信息。基本信息包括年龄、性别、教育程度、婚姻状况、吸烟和饮酒等信息。心脏病疾病患病信息根据问卷中“是否有医生曾经告诉过您有心脏病，如心肌梗塞、冠心病、心绞痛、充血性心力衰竭和其他心脏病?”判定是否有心血管疾病。
根据CHARLS研究对象的PSU代码匹配研究城市，收集相应城市的建成环境指标，具体包括：（1）人口密度；（2）土地利用混合度（entropy index，EI）：EI =-∑ (Aij*lnAij)/lnNj，其中Aij为第j个城市的第i种用地类型的面积，Nj为第j个城市的建设用地面积；（3）居住用地占比（%）：居住用地面积/城市建设用地面积；（4）工业用地占比（%）：工业用地面积/城市建设用地面积；（5）商业用地占比（%）：商业用地面积/城市建设用地面积；（6）绿地面积；（7）路网密度：为道路长度/城区面积；（8）道路面积率（%）：为道路面积/城区面积。（9）年均温度；（10）年降水量；（11）年均相对湿度。
1.3　统计学方法
本研究采用R 4.2.1软件进行统计分析。分类变量以频数（百分比）表示，使用χ2检验进行分析。使用Spearman秩相关系数评价建成环境和气象因素之间的相关性。多因素分析采用广义logistic回归分析，其中模型1未校正协变量；模型2校正性别、年龄、教育水平、婚姻状态、吸烟状态、饮酒状态、重体力活动、中体力活动、轻体力活动；模型3在模型2的基础上校正年降水量、年均相对湿度和年均气温。本研究还按性别进行分层，重复上述关联分析过程。使用加权分位数回归模型（weighted quantile sum，WQS）计算每种环境暴露在联合暴露效应中的权重。本研究统计推断均为双侧检验，α=0.05。
2　结果
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2.1　研究对象基本特征
本研究共纳入17 256名CHARLS中老年人作为研究对象，其中男性8 220名（47.64%），女性9 036名（52.36%）；平均年龄（61.4±9.7）岁；受教育程度为小学以下的有6 665名（38.62%），小学和初中的有8 616名（49.93%），高中及以上的有1 975名（11.45%）。高龄、女性、小学和初中学历、已婚、无重或中体力活动、无吸烟和饮酒的研究对象中，患心血管疾病风险更大（P<0.05）。见表1。人口密度、道路密度和道路面积率存在明显的正相关性（rs>0.7），居住用地占比和土地利用混合度存在明显的负相关性（rs=-0.76），其余因素之间相关性较弱（rs<0.35）。八种建成环境的相关性矩阵分析见图1。
2.2　建成环境暴露与中老年人群心血管疾病的关联
表2显示八种建成环境与心血管疾病的关联分析结果。模型3的多因素线性回归分析结果表明，土地利用混合度、居住用地占比、工业用地占比每增加1个IQR，心血管疾病患病风险分别升高13%、16%、11%，OR值为1.13（95%CI：1.07～1.19）、1.16（95%CI：1.10～1.23）、1.11（95%CI：1.06～1.16）。商业用地占比、绿地面积每增加1个IQR，心血管疾病患病风险降低，OR值分别为0.88（95%CI：0.85～0.92）、0.94（95%CI：0.90～0.98）。进行中老年性别分层后，土地利用混合度、居住用地占比、工业用地占比每增加1个IQR，男性中老年人心血管疾病患病风险均增加9%，OR值分别为1.09（95%CI：1.00～1.19）、1.09（95%CI：1.01～1.19）、1.09（95%CI：1.01～1.17）；女性心血管疾病患病风险分别增加16%、21%、12%，OR值分别为1.16（95%CI：1.07～1.25）、1.21（95%CI：1.13～1.30）、1.12（95%CI：1.05～1.19）。商业用地占比每增加1个IQR，男性、女性中老年人心血管病患病风险均明显降低，其中男性OR值为0.91（95%CI：0.85～0.97），女性OR值为0.87（95%CI：0.83～0.92）。除此之外绿地面积会降低女性心血管风险，OR值为0.93（95%CI：0.88～0.98）。见表3。
2.3　建成环境混合暴露对中老年人群心血管疾病患病风险的影响
负向结果显示建成环境混合暴露每增加一个单位，中老年人心血管疾病患病风险相应降低0.02（95%CI：-0.04～0.00）。正向结果显示建成环境混合暴露每增加一个单位，中老年人心血管患病风险增加0.11（95%CI：0.05～0.17），其中工业用地占比和居住用地占比对联合暴露效应的贡献最大，权重分别为34.13%和29.20%，其他建成环境对中老年人心血管疾病贡献率见图2。
3　讨论
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本研究结果发现土地利用混合度、居住用地占比和工业用地占比增加会升高心血管疾病患病风险，商业用地占比、绿地面积增加会降低心血管疾病患病风险。按性别进行分层分析发现，土地利用混合度、居住用地占比和工业用地占比均会增加男性和女性心血管疾病患病风险。商业用地占比均会降低男性和女性心血管疾病患病风险。绿地面积只降低女性心血管疾病患病风险。WQS回归模型结果显示，八种建成环境因素混合暴露增加会升高心血管疾病患病风险，其中权重较大的为工业用地占比和居住用地占比。
越来越多的研究显示建成环境会影响高血压、动脉粥样硬化、肥胖、糖尿病，进而影响心血管疾病的发生发展[8-11]。本研究发现土地利用混合度会增加心血管疾病风险，考虑可能是因为土地利用混合增大通过影响交通流量和汽车尾气排放，进而影响心血管疾病发生发展。目前国内外关于土地利用混合度对心血管健康的影响结论尚未达成一致，马来西亚[12]研究发现较高和高土地利用混合度对高血压有保护作用，但翟星星等人[13]研究显示土地混合度会增加循环系统死亡率。其次本研究还发现居住用地占比会增加心血管疾病风险，这和既往研究结果相似。谢波等人[14]运用空间回归分析方法发现高居住密度区居民患脑卒中的风险更高，这可能是因为高居住密度减少了娱乐活动设施数量，降低人群体力活动水平。多数研究显示绿地和心血管疾病存在密切关联。如冷红等人[15]研究显示住区绿地率、绿地感知质量、到街道绿地距离等均会降低心血管患病率。翟星星等人[13]通过分析中国17个城市建成环境和循环系统死亡率关系，发现居住用地占比、土地混合度增加会升高循环系统死亡率，人均绿化覆盖面积、商业用地占比增加会降低循环系统死亡率，该研究结果与本研究结果一致。
本研究观察到绿地面积仅对女性中老年人群心血管疾病存在显著关联，其他建成环境指标未发现明显的性别差异。Lai等[16]研究显示居住在NDVI前50%的居民，其动脉硬度指数较低，并且这种关系在女性和老年人更加明显。目前，这种性别差异产生的机制尚不明晰，但建成环境与体力活动之间的作用可能是潜在原因之一。体力活动是影响心血管健康、肥胖等多种慢性疾病的关键因素。浙江省宁波市研究显示服务可及性、步行和自行车道设施、土地利用混合度会显著增加男性休闲时间的步行分数，但对女性则没有显著影响。提示建成环境对不同性别心血管疾病的影响可能因其对体力活动影响机制不同而不同。WQS回归模型常见于多种化合物混合暴露分析，但其也可用于建成环境等其他因素暴露[17-18]。但WQS回归相关研究主要集中在绿地面积、大气污染物等方面，对于居住用地占比、工业用地占比等研究则鲜有报道。
本研究使用多因素logistic回归模型和WQS回归模型分析单因素暴露和混合暴露对心血管疾病患病的影响。本研究的局限性：（1）本研究仅为横断面研究，不能确认建成环境与心血管疾病之间的因果关联；（2）建成环境和气象因素为CHARLS人群所在城市的年均水平，未能精确到个体社区的环境暴露，个体环境暴露可能略有偏差；（3）回忆偏倚，本研究问卷心血管疾病患病信息为研究对象对医生诊断进行回顾性回答，研究对象的记忆失真可能使其准确性与真实情况不符。
综上所述，本研究发现土地利用混合度、居住用地占比和工业用地占比会增加中老年人群心血管疾病患病风险，工业用地占比、绿地面积会降低中老年人群心血管疾病患病风险，绿地面积对不同性别中老年人心血管疾病患病影响存在差异。
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2024年第51卷第9期
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doi: 10.20043/j.cnki.MPM.202312457
  • 接收时间：2023-12-25
  • 首发时间：2026-03-18
  • 出版时间：2024-05-10
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    中国疾病预防控制中心环境与健康相关产品安全所，北京 100021

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