University of New Brunswick, Fredericton, New Brunswick, Canada
Health Effects Institute, Boston, Massachusetts, USA.
BMJ Open. 2023 Feb 1;13(2):e067736. doi: 10.1136/bmjopen-2022-067736.
This population-based observational study explores the associations between individual-level and neighbourhood-level indices of active living with inpatient mental healthcare use among adults with an underlying chronic cardiometabolic condition.
Data from the 2013-2014 Canadian Community Health Survey were linked longitudinally to hospital records from the 2013/2014‒2017/2018 Discharge Abstract Database and to a geocoded measure of active living environments (ALE). Relationships between individuals' leisure-time physical activity and neighbourhood ALE with risk of hospital admission for mental health disorders were assessed using multivariable Cox regressions.
A national cohort was identified from the survey data of 24 960 respondents aged 35 years and above reporting having been diagnosed with diabetes, hypertension and/or heart disease.
Potentially avoidable hospitalisation for a mood, anxiety or substance use disorder over a 5-year period.
More than half (52%) of adults aged 35 years and above with a cardiometabolic disease were physically inactive in their daily lives, and one-third (34%) resided in the least activity-friendly neighbourhoods. The rate of being hospitalised at least once for a comorbid mental disorder averaged 8.1 (95% CI: 7.0 to 9.3) per 1000 person-years of exposure. Individuals who were at least moderately active were half as likely to be hospitalised for a comorbid mental health problem compared with those who were inactive (HR: 0.50 (95% CI: 0.38 to 0.65)). No statistically discernible associations between neighbourhood ALE and hospitalisation risks were found after controlling for individuals' behaviours and characteristics, including in separate models stratified by age group and by sex.
The evidence base to support prioritisation of interventions focusing on the built environment favouring mental health-promoting physical activity among higher-risk adults at the population level, independently of individual-level behaviours and characteristics, remains limited.
本基于人群的观察性研究探讨了个体层面和邻里层面的积极生活指标与患有潜在慢性心脏代谢疾病的成年人住院精神保健使用之间的关联。
2013-2014 年加拿大社区健康调查的数据与 2013/2014 年至 2017/2018 年出院摘要数据库中的住院记录以及积极生活环境（ALE）的地理编码测量值进行了纵向链接。使用多变量 Cox 回归评估个体的休闲时间体力活动和邻里 ALE 与心理健康障碍住院风险之间的关系。
从报告患有糖尿病、高血压和/或心脏病的 35 岁及以上的调查数据中确定了一个全国队列，共有 24960 名受访者。
在 5 年内，超过一半（52%）患有心脏代谢疾病的 35 岁及以上成年人日常生活中身体不活跃，三分之一（34%）居住在最不适合活动的社区。至少因共病精神障碍住院一次的发生率平均为每 1000 人年暴露率 8.1（95%CI：7.0 至 9.3）。与不活跃者相比，至少适度活跃的个体因共病精神健康问题住院的可能性降低一半（HR：0.50（95%CI：0.38 至 0.65））。在控制个体行为和特征（包括按年龄组和性别分层的单独模型）后，发现邻里 ALE 与住院风险之间没有统计学上可辨别的关联。
支持在人群层面优先考虑针对促进心理健康的体力活动的干预措施的证据基础仍然有限，这些干预措施侧重于对环境的干预，而不考虑个体层面的行为和特征。
