Am J Epidemiol. 2021 Jul 1;190(7):1270-1280. doi: 10.1093/aje/kwab043.
Sidewalks are indispensable environmental resources for daily life in that they encourage physical activity. However, the proportion of sidewalk coverage is low even in developed countries. We examined the association between neighborhood sidewalk environment and dementia in Japan. We conducted a 3-year follow-up (2010-2013) among participants in the Japan Gerontological Evaluation Study, a population-based cohort study of community-dwelling older adults. We ascertained the incidence of dementia for 76,053 participants from the public long-term care insurance system. We calculated sidewalk coverage (sidewalk area as a percentage of road area) within 436 residential neighborhood units using geographic information systems. Multilevel survival models were used to estimate hazard ratios for the incidence of dementia. During follow-up, 5,310 dementia cases were found. In urban areas, compared with the lowest quartile of sidewalk coverage, the hazard ratio was 0.42 (95% confidence interval: 0.33, 0.54) for the highest quartile, adjusting for individual covariates. After successive adjustments for other neighborhood factors (land slope; numbers of hospitals, grocery stores, parks, railway stations, and bus stops; educational level; and unemployment rate), the hazard ratio remained statistically significant (hazard ratio = 0.71, 95% confidence interval: 0.54, 0.92). Living in a neighborhood with a high level of sidewalk installation was associated with low dementia incidence in urban areas.
人行道是日常生活中不可或缺的环境资源，因为它们鼓励人们进行身体活动。然而，即使在发达国家，人行道的覆盖率也很低。我们研究了日本邻里人行道环境与痴呆症之间的关系。我们对参加日本老年评估研究的参与者进行了为期 3 年的随访（2010-2013 年），这是一项针对社区居住的老年人的基于人群的队列研究。我们从公共长期护理保险系统中确定了 76053 名参与者的痴呆症发病率。我们使用地理信息系统计算了 436 个居住邻里单元内的人行道覆盖率（人行道面积占道路面积的百分比）。多水平生存模型用于估计痴呆症发病率的风险比。在随访期间，发现了 5310 例痴呆症病例。在城市地区，与最低四分位的人行道覆盖率相比，最高四分位的风险比为 0.42（95%置信区间：0.33，0.54），调整了个体协变量。在连续调整其他邻里因素（地面坡度；医院、杂货店、公园、火车站和公共汽车站的数量；教育水平；和失业率）后，风险比仍然具有统计学意义（风险比=0.71，95%置信区间：0.54，0.92）。居住在人行道安装水平较高的邻里与城市地区的低痴呆症发病率相关。
