Asian Demographic Research Institute, Shanghai University, Shanghai, 200444, China.
The Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, University of Washington, Seattle, WA, 98195, USA.
Health Place. 2022 May;75:102778. doi: 10.1016/j.healthplace.2022.102778. Epub 2022 Mar 24.
There has been a generally negative view of the impact of urbanization on a rising burden of non-communicable diseases including cardiovascular disease. However, the evidence on the relationship between urbanization and cardiovascular health has remained inconclusive. A comprehensive picture of the relationship is lacking, given an implicit assumption that the longitudinal association between changes in cardiovascular health and an increasingly urbanized environment is similar between less and more urbanized communities, men and women. We used the longitudinal data on adults (18-64 years) from the China Health and Nutrition Survey (1991-2015) and employed within-between random-effects models to disaggregates the longitudinal and cross-sectional associations between urbanization and systolic/diastolic blood pressure (SBP/DBP) and examined heterogeneities in the longitudinal association by average urbanization level and gender. We found that the positive longitudinal association of urbanization with SBP/DBP was stronger in less urbanized than more urbanized communities. The cross-sectional association between urbanization and SBP was negative and significant, although the cross-sectional association between urbanization and DBP was of no statistical significance. Moreover, the positive longitudinal association between urbanization and DBP was stronger among men than women, although the gender heterogeneity in the longitudinal association of urbanization with SBP was not significant.
人们普遍认为城市化对包括心血管疾病在内的不断上升的非传染性疾病负担有负面影响。然而，城市化与心血管健康之间的关系的证据仍然没有定论。鉴于隐含的假设，即心血管健康变化与日益城市化环境之间的纵向关联在较少和更多城市化社区以及男性和女性之间是相似的，因此缺乏对这种关系的全面了解。我们使用了来自中国健康与营养调查（1991-2015 年）的成年人（18-64 岁）的纵向数据，并采用了个体间随机效应模型，将城市化与收缩压/舒张压（SBP/DBP）之间的纵向和横断面关联进行了细分，并按平均城市化水平和性别检查了纵向关联的异质性。我们发现，在城市化程度较低的社区中，城市化与 SBP/DBP 的正纵向关联要强于城市化程度较高的社区。尽管城市化与 DBP 之间的横断面关联没有统计学意义，但城市化与 SBP 之间的横断面关联呈负相关且显著。此外，城市化与 DBP 的正纵向关联在男性中强于女性，尽管城市化与 SBP 的纵向关联在性别上没有显著差异。
