Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA.
Department of City and Regional Planning, University of California, Berkeley, Berkeley, California, USA.
Environ Health Perspect. 2022 Feb;130(2):27010. doi: 10.1289/EHP7870. Epub 2022 Feb 15.
Features of the urban physical environment may be linked to the development of high blood pressure, a leading risk factor for global burden of disease.
We examined associations of urban physical environment features with hypertension and blood pressure measures in adults across 230 Latin American cities.
In this cross-sectional study we used health, social, and built environment data from the SALud URBana en América Latina (SALURBAL) project. The individual-level outcomes were hypertension and levels of systolic and diastolic blood pressure. The exposures were city and subcity built environment features, mass transit infrastructure, and green space. Odds ratios (ORs) and mean differences and 95% confidence intervals (CIs) were estimated using multilevel logistic and linear regression models, with single- and multiple-exposure models adjusted for individual-level age, sex, education, and subcity educational attainment.
A total of 109,176 participants from 230 cities and eight countries were included in the hypertension analyses and 50,228 participants from 194 cities and seven countries were included in the blood pressure measures analyses. Participants were 18-97 years of age. In multiple-exposure models, higher city fragmentation was associated with higher odds of having hypertension (; 95% CI: 1.01, 1.21); presence (vs. no presence) of mass transit in the city was associated with higher odds of having hypertension (; 95% CI: 1.09, 1.54); higher subcity population density was associated with lower odds of having hypertension (; 95% CI: 0.85, 0.94); and higher subcity intersection density was associated with higher odds of having hypertension [; 95% CI: 1.04, 1.15). The presence of mass transit was also associated with slightly higher systolic and diastolic blood pressure in multiple-exposure models adjusted for treatment. Except for the association between intersection density and hypertension, associations were attenuated after adjustment for country. An inverse association of greenness with continuous blood pressure emerged after country adjustment.
Our results suggest that urban physical environment features-such as fragmentation, mass transit, population density, and intersection density-may be related to hypertension in Latin American cities. Reducing chronic disease risks in the growing urban areas of Latin America may require attention to integrated management of urban design and transport planning. https://doi.org/10.1289/EHP7870.
城市物理环境的特点可能与高血压的发展有关，高血压是全球疾病负担的主要危险因素之一。
我们研究了 230 个拉丁美洲城市的城市物理环境特征与成年人高血压和血压测量值之间的关联。
在这项横断面研究中，我们使用了 SALud URBana en América Latina (SALURBAL) 项目的健康、社会和建筑环境数据。个体水平的结果是高血压和收缩压及舒张压水平。暴露因素是城市和分区的建筑环境特征、公共交通基础设施和绿地。使用多水平逻辑回归和线性回归模型估计比值比 (OR) 和均值差异及 95%置信区间 (CI)，使用单因素和多因素暴露模型调整个体水平的年龄、性别、教育程度和分区教育程度。
共有来自 8 个国家 230 个城市的 109176 名参与者纳入高血压分析，来自 7 个国家 194 个城市的 50228 名参与者纳入血压测量分析。参与者年龄在 18-97 岁之间。在多因素暴露模型中，较高的城市破碎度与较高的高血压患病几率相关（95%CI：1.01，1.21）；城市中存在（而非不存在）公共交通与较高的高血压患病几率相关（95%CI：1.09，1.54）；较高的分区人口密度与较低的高血压患病几率相关（95%CI：0.85，0.94）；较高的分区交叉点密度与较高的高血压患病几率相关（95%CI：1.04，1.15）。在多因素暴露模型中，经治疗调整后，公共交通的存在也与收缩压和舒张压略有升高相关。除了交叉点密度与高血压之间的关联，在调整国家因素后，关联强度减弱。在调整国家因素后，与绿色空间呈负相关的连续血压结果出现。
我们的结果表明，城市物理环境特征，如破碎度、公共交通、人口密度和交叉点密度，可能与拉丁美洲城市的高血压有关。要降低拉丁美洲不断增长的城市地区的慢性病风险，可能需要关注城市设计和交通规划的综合管理。https://doi.org/10.1289/EHP7870.
