安静、清洁、绿色、活跃：城市空间相关暴露对一系列身体健康结果影响的系统评价导航指南。

Quiet, clean, green, and active: A Navigation Guide systematic review of the impacts of spatially correlated urban exposures on a range of physical health outcomes.

机构信息

School of Population and Public Health, University of British Columbia, 3rd Floor - 2206 East Mall, Vancouver, BC V6T1Z3, Canada.

School of Population and Public Health, University of British Columbia, 3rd Floor - 2206 East Mall, Vancouver, BC V6T1Z3, Canada; Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA 98121, USA.

出版信息

Environ Res. 2020 Jun;185:109388. doi: 10.1016/j.envres.2020.109388. Epub 2020 Mar 19.

DOI:10.1016/j.envres.2020.109388

PMID:32244108

Abstract

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.

摘要

背景

最近的流行病学分析考虑了多种空间相关的城市暴露因素的影响，但这方面的文献尚未得到系统评估。

目的

通过评估至少有两种此类暴露因素与死亡率、心血管疾病、慢性呼吸道疾病、过敏、2 型糖尿病或生殖结果相关的研究，来描述交通相关空气污染（TRAP）、噪声、自然空间和邻里可步行性这四种截然不同的空间相关城市环境暴露因素的长期影响。

方法

根据导航指南框架，检索了自 2003 年以来发表的研究，并符合预先确定的纳入标准。单独对确定的研究进行了偏倚风险评分，对与暴露组集相关的所有研究进行了总体质量和证据强度评估。

结果

共纳入 51 项独立研究（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、自然空间和可步行性：n=3）。当同时考虑 TRAP 和噪声时，证据足以证明较高的噪声暴露会增加心血管发病率；TRAP 对 CVD 发病率没有影响的证据充足；TRAP 暴露量增加与死亡率增加有关，但噪声的证据有限；TRAP 暴露量增加与不良生殖结果增加有关，但噪声没有影响的证据有限。研究自然空间和 TRAP 之间的关系时，有有限的证据表明，自然空间越大，患慢性呼吸道疾病的风险越低，新生儿体重增加越小；这种与新生儿体重的关系在调整噪声后仍然存在。对于其他所有暴露组和结果，证据不足。