Associations of perceived built environment characteristics using NEWS questionnaires with all-cause mortality and major cardiovascular diseases: The prospective urban rural epidemiology (PURE)-China study

2024  Journal Article

Associations of perceived built environment characteristics using NEWS questionnaires with all-cause mortality and major cardiovascular diseases: The prospective urban rural epidemiology (PURE)-China study

Pub TLDR

This study found that a more favorable perceived built environment was associated with a lower risk of all-cause mortality and major cardiovascular disease in the Chinese population, particularly in urban areas and among females. This suggests that improving community conditions, such as amenities and transportation, could have a positive impact on health outcomes.

 

College of Health researcher(s)

OSU Profile

Highlights

  • Higher score of perceived NEWS links to a lower risk of all-cause mortality and major CVD.
  • The association was observed in females and urban areas, but not in other demographic groups.
  • Developing healthy neighborhood environment may be an important strategy.

Abstract

Background

Despite increased literature focusing on the role of the built environment (BE) in health, few cohort studies have quantitatively analyzed neighborhood walkability environment in relation to the risk of death and cardiovascular disease (CVD). This longitudinal study aimed at evaluating the association between perceived BE attributes with mortality and major CVD based on the Prospective Urban Rural Epidemiology study in China (PURE-China).

Methods

The PURE-China study recruited 47,931 participants aged 35–70 years from 12 provinces of China between 2005 and 2009. The perceived BE information, including land use, street, aesthetics, and safety, was collected using the neighborhood environment walkability scale (NEWS) questionnaire, with higher scores indicating a more favorable rating. Two primary outcomes are all-cause mortality and major CVD event. The Cox frailty model with random intercepts was used to assess the association between the perceived total BE/subscales score and outcomes.

Results

Of 32,163 participants included in this study, 19,253 (59.9 %) were women, and the mean (SD) age was 51.0 (9.5) years. After a median follow-up period of 11.7 years (IQR 9.4 – 12.2), we observed that one standard deviation higher of combined BE scores was related to a lower risk of all-cause mortality (HR = 0.85; 95 %CI, 0.80–0.90), and major CVD events (HR = 0.95; 95 %CI, 0.90–0.99). The subscales of perceived BE were related to a lower risk, although a few were not significant. Land use mix-diversity and safety from crime were the two most significant subscales. Stronger risks were observed among urban and female participants.

Conclusion

Favorable perceived BE characteristics were linked with a lower risk of all-cause mortality and major CVD events in Chinese population, especially in urban areas and females. Our findings can be used by policymakers to take action to mitigate the adverse effect of poor community conditions on health, such as improving local amenities and transport connectivity, providing building paths for walking, running and cycling.

Li, M., Li, Y., Liu, Z., Hystad, P., Rangarajan, S., Tse, L.A., Lear, S.A., Ma, Y., Chen, M., Han, G., Li, R., Yusuf, S., Liu, L., Hu, B., Li, W.(2024)Associations of perceived built environment characteristics using NEWS questionnaires with all-cause mortality and major cardiovascular diseases: The prospective urban rural epidemiology (PURE)-China studyEnvironment International187