Department of Public Health, Policy and Systems, University of Liverpool, UK; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, UK.
Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, UK.
Health Place. 2021 Sep;71:102645. doi: 10.1016/j.healthplace.2021.102645. Epub 2021 Aug 11.
Effects of residential neighbourhood environments on health may vary across geographical space, with differences in local contexts influencing how much a given neighbourhood characteristic matters for the health of local residents. Linking UK Biobank data from 302,952 urban-dwelling adults in England, collected between 2006 and 2010, to publicly available Local Authority-level data, we examined (a) whether cross-sectional associations between body mass index (BMI) and two characteristics of the neighbourhood built environment (availability of formal physical activity facilities near home, and fast-food proximity) vary by Local Authority (LA), and (b) whether cross-level interactions with LA-level physical features (natural landcover) and socio-cultural attributes (local obesity norms) reveal evidence of effect modification by these features of the wider contexts in which neighbourhoods are located. We found variation across urban England in the relationship between availability of neighbourhood formal physical activity facilities and BMI, and some evidence suggesting this association was stronger among people living in areas with less natural landcover, especially in areas outside of London. We also found that the relationship between proximity of fast-food stores to people's homes and BMI varied geographically across England. Local descriptive obesity norms were not an important modifier of this association. This paper highlights the importance of considering potential geographical heterogeneity in relationships between the built environment and health, and the implications for generalisability of research findings. By seeking to better understand sources of geographical heterogeneity, we may be able to better adapt and target built environment interventions for population health improvement.
居住社区环境对健康的影响可能因地理位置而异，当地环境的差异影响着特定社区特征对当地居民健康的重要程度。本研究将 2006 年至 2010 年间在英格兰居住的 302952 名城市成年人的英国生物银行（UK Biobank）数据与公开的地方当局（LA）层面数据相链接，利用这些数据，我们检验了：（a）身体质量指数（BMI）与社区建成环境的两个特征（家庭附近是否有正式的体育活动设施以及快餐的临近程度）之间的横断面关联是否因 LA 而异；（b）LA 层面的物理特征（自然土地覆盖）和社会文化属性（当地肥胖规范）与这些邻里环境所在的更广泛的背景特征之间的交叉层次相互作用是否为这些邻里环境的特征提供了效应修饰的证据。研究发现，在英国城市中，社区正式体育活动设施的可用性与 BMI 之间的关系存在差异，有一些证据表明，这种关联在自然土地覆盖较少的地区生活的人群中更强，尤其是在伦敦以外的地区。我们还发现，快餐店与人们家之间的距离与 BMI 之间的关系在英格兰各地存在地域差异。当地描述性肥胖规范并不是这种关联的重要修饰因素。本文强调了考虑建成环境与健康之间关系中潜在的地理异质性的重要性，以及研究结果的普遍性的意义。通过寻求更好地理解地理异质性的来源，我们也许能够更好地适应和针对人口健康改善的建成环境干预措施。
