Poulsen Melissa N, Schwartz Brian S, Dewalle Joseph, Nordberg Cara, Pollak Jonathan S, Silva Jennifer, Mercado Carla I, Rolka Deborah B, Siegel Karen Rae, Hirsch Annemarie G
Department of Population Health Sciences, Geisinger, Danville, PA.
Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Landsc Urban Plan. 2021 May;209. doi: 10.1016/j.landurbplan.2021.104060.
Salutogenic effects of living near aquatic areas (blue space) remain underexplored, particularly in non-coastal and non-urban areas. We evaluated associations of residential proximity to inland freshwater blue space with new onset type 2 diabetes (T2D) in central and northeast Pennsylvania, USA, using medical records to conduct a nested case-control study. T2D cases (n=15,888) were identified from diabetes diagnoses, medication orders, and laboratory test results and frequency-matched on age, sex, and encounter year to diabetes-free controls (n=79,435). We calculated distance from individual residences to the nearest lake, river, tributary, or large stream, and residence within the 100-year floodplain. Logistic regression models adjusted for community socioeconomic deprivation and other confounding variables and stratified by community type (townships [rural/suburban], boroughs [small towns], city census tracts). Compared to individuals living ≥1.25 miles from blue space, those within 0.25 miles had 8% and 17% higher odds of T2D onset in townships and boroughs, respectively. Among city residents, T2D odds were 38-39% higher for those living 0.25 to <0.75 miles from blue space. Residing within the floodplain was associated with 16% and 14% higher T2D odds in townships and boroughs. A post-hoc analysis demonstrated patterns of lower residential property values with nearer distance to the region's predominant waterbody, suggesting unmeasured confounding by socioeconomic disadvantage. This may explain our unexpected findings of higher T2D odds with closer proximity to blue space. Our findings highlight the importance of historic and economic context and interrelated factors such as flood risk and lack of waterfront development in blue space research.
居住在水域附近（蓝色空间）的健康促进作用仍未得到充分研究，尤其是在非沿海和非城市地区。我们在美国宾夕法尼亚州中部和东北部评估了居住在内陆淡水蓝色空间附近与2型糖尿病（T2D）新发病例之间的关联，利用医疗记录进行了一项巢式病例对照研究。T2D病例（n = 15888）通过糖尿病诊断、用药医嘱和实验室检查结果确定，并在年龄、性别和就诊年份上与无糖尿病对照（n = 79435）进行频率匹配。我们计算了从个人住所到最近的湖泊、河流、支流或大溪流的距离，以及是否居住在百年一遇洪泛区内。逻辑回归模型对社区社会经济剥夺和其他混杂变量进行了调整，并按社区类型（乡镇[农村/郊区]、自治市镇[小镇]、城市普查区）进行分层。与居住在距离蓝色空间≥1.25英里处的个体相比，居住在0.25英里范围内的个体在乡镇和自治市镇患T2D的几率分别高出8%和17%。在城市居民中，居住在距离蓝色空间0.25至<0.75英里处的个体患T2D的几率高出38 - 39%。居住在洪泛区内与乡镇和自治市镇患T2D的几率分别高出16%和14%相关。一项事后分析表明，离该地区主要水体越近，住宅物业价值越低，这表明存在未测量的社会经济劣势混杂因素。这可能解释了我们关于离蓝色空间越近患T2D几率越高的意外发现。我们的研究结果凸显了历史和经济背景以及诸如洪水风险和蓝色空间缺乏滨水开发等相互关联因素在蓝色空间研究中的重要性。
