Roy Brita, Hajduk Alexandra M, Tsang Sui, Geda Mary, Riley Carley, Krumholz Harlan M, Chaudhry Sarwat I
Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, United States.
Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States.
Prev Med Rep. 2021 Apr 30;23:101391. doi: 10.1016/j.pmedr.2021.101391. eCollection 2021 Sep.
Physical activity and social support are associated with better outcomes after surviving acute myocardial infarction (AMI), and greater walkability has been associated with activity and support. We used data from the SILVER-AMI study (November 2014-June 2017), a longitudinal cohort of community-living adults ≥ 75 years hospitalized for AMI to assess associations of neighborhood walkability with health outcomes, and to assess whether physical activity and social support mediate this relationship, if it exists. We included data from 1345 participants who were not bedbound, were discharged home, and for whom we successfully linked walkability scores (from Walk Score®) for their home census block. Our primary outcome was hospital-free survival time (HFST) at six months after discharge; secondary outcomes included physical and mental health at six months, assessed using SF-12. Physical activity and social support were measured at baseline. Covariates included cognition, functioning, comorbidities, participation in rehabilitation or physical therapy, and demographics. We employed survival analysis to examine associations between walkability and HFST, before and after adjustment for covariates; we repeated analyses using linear regression with physical and mental health as outcomes. In adjusted models, walkability was not associated with physical health (ß = 0.010; 95% CI: -0.027, 0.047), mental health (ß = -0.08; 95% CI: -0.175, -0.013), or HFST (ß = 0.008; 95% CI: -0.023, 0.009). Social support was associated with mental health in adjusted models. Neighborhood walkability was not predictive of outcomes among older adults with existing coronary disease, suggesting that among older adults, mobility limitations may supercede neighborhood walkability.
身体活动和社会支持与急性心肌梗死（AMI）存活后的更好预后相关，更高的步行便利性与活动和支持相关。我们使用了SILVER-AMI研究（2014年11月至2017年6月）的数据，这是一个≥75岁因AMI住院的社区居住成年人的纵向队列，以评估邻里步行便利性与健康结局的关联，并评估身体活动和社会支持是否介导这种关系（如果存在的话）。我们纳入了1345名参与者的数据，这些参与者没有卧床不起，已出院回家，并且我们成功地将他们家庭普查街区的步行便利性得分（来自Walk Score®）进行了关联。我们的主要结局是出院后六个月的无住院生存时间（HFST）；次要结局包括六个月时的身心健康，使用SF-12进行评估。身体活动和社会支持在基线时进行测量。协变量包括认知、功能、合并症、参与康复或物理治疗以及人口统计学特征。我们采用生存分析来检查在调整协变量之前和之后步行便利性与HFST之间的关联；我们使用以身心健康为结局的线性回归重复分析。在调整后的模型中，步行便利性与身体健康（β = 0.010；95% CI：-0.027，0.047）、心理健康（β = -0.08；95% CI：-0.175，-0.013）或HFST（β = 0.008；95% CI：-0.023，0.009）均无关联。在调整后的模型中，社会支持与心理健康相关。邻里步行便利性不能预测患有现有冠心病的老年人的结局，这表明在老年人中，行动能力限制可能超过邻里步行便利性。
