Wu Yonghao, Shen Peng, Yang Zongming, Yu Luhua, Zhu Zhanghang, Li Tiezheng, Xu Lisha, Luo Dan, Yao Xuecheng, Zhang Xinhan, Meng Lin, Lin Hongbo, Shui Liming, Tang Mengling, Jin Mingjuan, Chen Kun, Wang Jianbing
Department of Public Health, National Clinical Research Center for Child Health of Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China.
Department of Chronic Disease and Health Promotion, Yinzhou District Center for Disease Control and Prevention, Ningbo 315040, China.
Sci Total Environ. 2023 Feb 1;858(Pt 1):159780. doi: 10.1016/j.scitotenv.2022.159780. Epub 2022 Oct 26.
Walkability has been considered to be associated with metabolic and cardiovascular diseases, but the relationship between walkability and chronic obstructive pulmonary disease (COPD) remains unclear. Moreover, fine particulate matter (PM), possibly positively correlated to walkability, may lead to an increased risk of COPD. The separate and joint effects of PM and walkability on risk of COPD were explored in our study.
We used prospective data of 29,572 participants from the Yinzhou cohort in Ningbo, China. COPD cases were diagnosed based on the Yinzhou Health Information System (YHIS). Walkability was measured using walk score in relation to the built environment based on geographic information systems (GIS). Air pollution levels were assessed by fitting land use regression (LUR) models. Cox proportional hazards models were used to evaluate the relationships of PM and walkability with COPD. Furthermore, we also examined additive and multiplicative interactions between walkability and PM.
Overall, a total of 29,572 participants were included in the final analysis and 722 COPD incident cases were identified during 134,846 person-years of follow-up. Compared with subjects with lower walkability, individuals with higher walkability had a decreased risk of COPD (HR = 0.88, 95 % CI: 0.82-0.95) for every IQR increase. By contrast, exposure to PM (every IQR increase) was associated with an elevated risk of COPD (HR = 1.21, 95 % CI: 1.06-1.37). No interaction between PM and walkability was observed.
Living in a highly walkable neighborhood could decrease risk of COPD, whereas high levels of PM were positively associated with COPD. In addition, the beneficial effects of walkability were not attenuated by exposure to PM.
可步行性被认为与代谢性疾病和心血管疾病有关，但可步行性与慢性阻塞性肺疾病（COPD）之间的关系仍不明确。此外，与可步行性可能呈正相关的细颗粒物（PM），可能会导致COPD风险增加。我们的研究探讨了PM和可步行性对COPD风险的单独及联合影响。
我们使用了来自中国宁波鄞州队列的29572名参与者的前瞻性数据。COPD病例根据鄞州健康信息系统（YHIS）进行诊断。可步行性通过基于地理信息系统（GIS）的与建成环境相关的步行分数来衡量。空气污染水平通过拟合土地利用回归（LUR）模型进行评估。采用Cox比例风险模型评估PM和可步行性与COPD的关系。此外，我们还研究了可步行性和PM之间的相加和相乘交互作用。
总体而言，共有29572名参与者纳入最终分析，在134846人年的随访期间确定了722例COPD发病病例。与可步行性较低的受试者相比，可步行性较高的个体每增加一个四分位数间距（IQR），患COPD的风险降低（HR = 0.88，95%CI：0.82 - 0.95）。相比之下，暴露于PM（每增加一个IQR）与COPD风险升高相关（HR = 1.21，95%CI：1.06 - 1.37）。未观察到PM和可步行性之间的交互作用。
生活在步行便利性高的社区可降低患COPD的风险，而高水平的PM与COPD呈正相关。此外，可步行性的有益影响不会因暴露于PM而减弱。
