BACKGROUND Recent epidemiologic analyses have considered impacts of multiple spatially correlated urban exposures, but this literature has not been systematically evaluated. OBJECTIVES To characterize the long-term impacts of four distinct spatially correlated urban environmental exposures - traffic-related air pollution (TRAP), noise, natural spaces, and neighborhood walkability - by evaluating studies including measures of at least two such exposures in relationship to mortality, cardiovascular disease, chronic respiratory disease, allergy, type 2 diabetes, or reproductive outcomes. METHODS Following the Navigation Guide framework, the literature was searched for studies published since 2003 and meeting predefined inclusion criteria. Identified studies were scored individually for risk of bias and all studies related to an exposure-group set were appraised for overall quality and strength of evidence. RESULTS A total of 51 individual studies (TRAP and noise: n = 29; TRAP and natural spaces: n = 10; noise and natural spaces: n = 2; TRAP, noise, and natural spaces: n = 7; TRAP, noise, natural spaces, and walkability: n = 3) were included. When TRAP and noise were considered jointly, evidence was sufficient for increased cardiovascular morbidity with higher noise exposures; sufficient for no effect of TRAP on CVD morbidity; sufficient for increased mortality with higher TRAP exposures, but limited for noise; and limited for increased adverse reproductive outcomes with higher TRAP exposures and no effect of noise. Looking at natural spaces and TRAP, there was limited evidence for lower risk of chronic respiratory disease and small increases in birthweight with greater natural space; this relationship with birthweight persisted after adjustment for noise as well. Evidence was inadequate for all other exposure groups and outcomes. DISCUSSION Studies that properly account for the complexity of relationships between urban form and physical health are limited but suggest that even highly correlated exposures may have distinct effects. REVIEW REGISTRATION PROSPERO 2018 CRD42018106050.

中文翻译：

---

安静，干净，绿色和主动：《导航指南》系统回顾了与空间相关的城市暴露对一系列身体健康结果的影响。

背景技术最近的流行病学分析已经考虑了多种与空间相关的城市暴露的影响，但是尚未对该文献进行系统评价。目的通过评估研究（包括至少两种此类暴露与死亡率的关系测量）来表征四种不同的空间相关城市环境暴露（交通相关空气污染（TRAP），噪声，自然空间和邻里可步行性）的长期影响，心血管疾病，慢性呼吸道疾病，过敏，2型糖尿病或生殖结局。方法按照“导航指南”框架，从文献中搜索自2003年以来发表并符合预定纳入标准的研究。对鉴定出的研究分别进行偏倚风险评分，并评估与暴露组相关的所有研究的总体质量和证据强度。结果总共进行了51项单独研究（TRAP和噪声：n = 29; TRAP和自然空间：n = 10;噪声和自然空间：n = 2; TRAP，噪声和自然空间：n = 7; TRAP，噪声，自然空间和步行性：n = 3）。当同时考虑TRAP和噪声时，有足够的证据证明较高的噪声暴露会增加心血管疾病的发病率。不足以使TRAP对CVD发病率没有影响；通过较高的TRAP暴露量足以增加死亡率，但对于噪音却有限；并且受限于TRAP暴露量增加且无噪音影响的不良生殖结果增加。观察自然空间和陷阱，有限的证据表明，患慢性呼吸道疾病的风险较低，而出生体重稍有增加，自然空间较大；调整噪声后，这种与出生体重的关系也持续存在。对于所有其他暴露组和结果，证据不足。讨论适当解释了城市形态与身体健康之间关系的复杂性的研究有限，但表明即使高度相关的暴露也可能产生明显的影响。审查注册PROSPERO 2018 CRD42018106050。讨论适当解释了城市形态与身体健康之间关系的复杂性的研究有限，但表明即使高度相关的暴露也可能产生明显的影响。审查注册PROSPERO 2018 CRD42018106050。讨论适当解释了城市形态与身体健康之间关系的复杂性的研究有限，但表明即使高度相关的暴露也可能产生明显的影响。审查注册PROSPERO 2018 CRD42018106050。