West China Biomedical Big Data Center, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, 610040, Sichuan, China.
BMC Public Health. 2020 Nov 16;20(1):1728. doi: 10.1186/s12889-020-09876-y.
Neighborhood factors have gained increasing attention, while the association between the neighborhood's characteristics and multimorbidity has not been clarified. In this study, we aim to depict variations in the number of non-communicable chronic diseases (NCDs) as a function of urban vs. rural settings and road types.
The present cross-sectional study derived data from the China Health and Retirement Longitudinal Study 2011 National Baseline Survey. Negative binomial regression with clustered robust standard errors was performed to analyze variations in the number of NCDs among 13,414 Chinese middle-aged and older adults. Logistic regression models were employed to investigate the association between neighborhood-level characteristics and each NCD, respectively.
First, over 65% of subjects had at least one NCDs, and over 35% had multimorbidity. Arthritis (33.08%), hypertension (24.54%), and digestive disease (21.98%) were the most prevalent NCDs. Urban vs. rural differences in multimorbidity were fully explained by neighborhood clustering variations (IRR = 1.02, 95% CI, 0.95-1.10). Living with paved roads was associated with a smaller number of NCDs relative to living with unpaved roads (IRR = 0.86, 95% CI, 0.78-0.95). Results from subgroup analyses suggested that in comparison with those living with unpaved roads, individuals living with paved roads respectively had lower odds of chronic lung disease (OR = 0.76, 95% CI, 0.63-0.93), chronic liver disease (OR = 0.74, 95% CI, 0.55-0.99), chronic kidney disease (OR = 0.68, 95% CI, 0.51-0.89), digestive disease (OR = 0.82, 95% CI, 0.69-0.97), arthritis or rheumatism (OR = 0.69, 95% CI, 0.55-0.87), and asthma (OR = 0.67, 95% CI, 0.51-0.88).
Urban vs. rural disparities in multimorbidity appeared to result from within-neighborhoods characteristics. The improvement in neighborhood-level characteristics, such as road pavement, holds promise to alleviate the increasing disease burden of chronic diseases.
社区因素越来越受到关注，而社区特征与多种疾病之间的关联尚未阐明。本研究旨在描绘非传染性慢性病（NCDs）数量的变化，作为城市与农村环境和道路类型的函数。
本横断面研究的数据来自中国健康与退休纵向研究 2011 年国家基线调查。使用聚类稳健标准误差的负二项回归分析了 13414 名中国中老年人中 NCD 数量的变化。分别使用逻辑回归模型研究了社区水平特征与每种 NCD 的关联。
首先，超过 65%的受试者至少有一种 NCD，超过 35%的受试者患有多种疾病。关节炎（33.08%）、高血压（24.54%）和消化系统疾病（21.98%）是最常见的 NCD。城市与农村地区多种疾病的差异完全可以用社区聚类变化来解释（IRR=1.02，95%CI，0.95-1.10）。与未铺砌道路相比，居住在铺砌道路上的人患 NCD 的数量较少（IRR=0.86，95%CI，0.78-0.95）。亚组分析结果表明，与居住在未铺砌道路上的人相比，居住在铺砌道路上的人分别患有慢性肺病（OR=0.76，95%CI，0.63-0.93）、慢性肝病（OR=0.74，95%CI，0.55-0.99）、慢性肾病（OR=0.68，95%CI，0.51-0.89）、消化系统疾病（OR=0.82，95%CI，0.69-0.97）、关节炎或风湿病（OR=0.69，95%CI，0.55-0.87）和哮喘（OR=0.67，95%CI，0.51-0.88）的可能性较低。
城市与农村地区多种疾病的差异似乎是由邻里特征引起的。改善社区一级的特征，如道路铺设，有望减轻慢性病不断增加的疾病负担。
