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Modifications to residential neighbourhood characteristics and risk of 79 common health conditions: a prospective cohort study
The Lancet Public Health ( IF 50.0 ) Pub Date : 2021-05-26 , DOI: 10.1016/s2468-2667(21)00066-9
Mika Kivimäki 1 , G David Batty 2 , Jaana Pentti 3 , Solja T Nyberg 4 , Joni V Lindbohm 5 , Jenni Ervasti 6 , Carlos Gonzales-Inca 7 , Sakari B Suominen 8 , Sari Stenholm 9 , Pyry N Sipilä 5 , Payam Dadvand 10 , Jussi Vahtera 9
Affiliation  

Background

Observational studies have identified a link between unfavourable neighbourhood characteristics and increased risk of morbidity, but it is unclear whether changes in neighbourhoods affect future disease risk. We used a data-driven approach to assess the impact of neighbourhood modification on 79 health outcomes.

Methods

In this prospective cohort study, we used pooled, individual-level data from two Finnish cohort studies: the Health and Social Support study and the Finnish Public Sector study. Neighbourhood characteristics (mean educational level, median income, and employment rate of residents, and neighbourhood green space) and individual lifestyle factors of community-dwelling individuals were assessed at baseline (at different waves starting between 1998 and 2013). We repeated assessment of neighbourhood characteristics and lifestyle factors approximately 5 years from each baseline assessment, after which follow-up began for health conditions diagnosed according to the WHO International Classification of Diseases for 79 common health conditions using linkage to electronic health records. We used Cox proportional hazard regression models to compute adjusted hazard ratios (HRs) of incident disease associated with neighbourhood characteristics and changes in neighbourhood characteristics over time and logistic regression analysis to compute adjusted odds of association between changes in neighbourhood characteristics and individual lifestyle factors.

Findings

114 786 individuals (87 012 [75·8%] women; mean age 44·4 years [SD 11·1]) had complete data and were included in this cohort study. During 1·17 million person-years at risk, we recorded 164 368 new-onset health conditions and 3438 deaths. Favourable changes in neighbourhood characteristics were associated with reduced risk of all-cause mortality and incidence of 19 specific health conditions. Unfavourable changes were correspondingly associated with increased risk of mortality and 27 specific health conditions. Among participants who did not move residence during the observation period, relative to individuals who continually lived in disadvantaged neighbourhoods, those who experienced favourable modifications in neighbourhood characteristics had a lower risk of future diabetes (HR 0·84, 95% CI 0·75–0·93), stroke (0·49, 0·29–0·83), skin disease (0·72, 0·53–0·97), and osteoarthritis (0·87, 0·77–0·99). Living in a neighbourhood with improving characteristics was also associated with improvements in individual-level health-related lifestyle factors. Among participants who lived in advantaged residential environments at baseline, unfavourable changes in neighbourhood characteristics were associated with an increased risk of diabetes, stroke, skin disease, and osteoarthritis compared with individuals who lived in advantaged neighbourhoods throughout the study period.

Interpretation

Favourable modifications to residential neighbourhoods showed robust, longitudinal associations with a range of improvements in health outcomes, including improved health behaviours and reduced risk of cardiometabolic, infectious, and orthopaedic conditions.

Funding

UK Medical Research Council, US National Institute on Aging, NordForsk, and Academy of Finland.



中文翻译:

对居民区特征和 79 种常见健康状况风险的修改:一项前瞻性队列研究

背景

观察性研究已经确定了不利的社区特征与发病风险增加之间的联系,但尚不清楚社区的变化是否会影响未来的疾病风险。我们使用数据驱动的方法来评估社区改造对 79 项健康结果的影响。

方法

在这项前瞻性队列研究中,我们使用了来自两项芬兰队列研究的汇总的个人水平数据:健康与社会支持研究和芬兰公共部门研究。在基线(从 1998 年到 2013 年开始的不同阶段)评估社区居民的社区特征(平均教育水平、收入中位数、居民就业率和社区绿地)和个人生活方式因素。我们在每次基线评估后大约 5 年重复评估邻里特征和生活方式因素,之后使用与电子健康记录相关联的方式对根据 WHO 国际疾病分类对 79 种常见健康状况诊断出的健康状况进行随访。

发现

114 786 人(87 012 [75·8%] 名女性;平均年龄 44·4 岁 [SD 11·1])拥有完整的数据并被纳入该队列研究。在 1·1700 万人年的风险中,我们记录了 164 368 例新发健康状况和 3438 例死亡。社区特征的有利变化与全因死亡率和 19 种特定健康状况的发病率降低有关。不利的变化相应地与死亡风险增加和 27 种特定健康状况相关。在观察期间没有搬家的参与者中,相对于持续居住在贫困社区的个体,那些对社区特征进行了有利改变的人未来患糖尿病的风险较低(HR 0·84, 95% CI 0·75– 0·93), 行程 (0·49, 0·29–0·83), 皮肤病 (0·72, 0·53–0·97) 和骨关节炎 (0·87, 0·77–0·99)。生活在具有改善特征的社区也与个人健康相关生活方式因素的改善有关。在基线时居住在优越居住环境中的参与者中,与整个研究期间居住在优越社区的个体相比,社区特征的不利变化与糖尿病、中风、皮肤病和骨关节炎的风险增加有关。

解释

对居民区的有利改造表明,与一系列健康结果的改善有着强大的纵向关联,包括改善健康行为和降低心脏代谢、传染性和骨科疾病的风险。

资金

英国医学研究委员会、美国国家老龄化研究所、NordForsk 和芬兰科学院。

更新日期:2021-05-27
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