Department of Population Health, New York University Grossman School of Medicine, New York, New York.
Department of Population Health, New York University Grossman School of Medicine, New York, New York.
Am J Prev Med. 2023 Apr;64(4):468-476. doi: 10.1016/j.amepre.2022.10.008.
The purpose of this study is to examine the associations between built environments and life expectancy across a gradient of urbanicity in the U.S.
Census tract‒level estimates of life expectancy between 2010 and 2015, except for Maine and Wisconsin, from the U.S. Small-Area Life Expectancy Estimates Project were analyzed in 2022. Tract-level measures of the built environment included: food, alcohol, and tobacco outlets; walkability; park and green space; housing characteristics; and air pollution. Multilevel linear models for each of the 4 urbanicity types were fitted to evaluate the associations, adjusting for population and social characteristics.
Old housing (built before 1979) and air pollution were important built environment predictors of life expectancy disparities across all gradients of urbanicity. Convenience stores were negatively associated with life expectancy in all urbanicity types. Healthy food options were a positive predictor of life expectancy only in high-density urban areas. Park accessibility was associated with increased life expectancy in all areas, except rural areas. Green space in neighborhoods was positively associated with life expectancy in urban areas but showed an opposite association in rural areas.
After adjusting for key social characteristics, several built environment characteristics were salient risk factors for decreased life expectancy in the U.S., with some measures showing differential effects by urbanicity. Planning and policy efforts should be tailored to local contexts.
本研究旨在探讨美国城市化梯度下的建成环境与预期寿命之间的关联。
在 2022 年，分析了美国小区域预期寿命估计项目在 2010 年至 2015 年期间除缅因州和威斯康星州之外的普查区层面预期寿命的估计值。建成环境的普查区层面衡量指标包括：食品、酒精和烟草销售点；步行性；公园和绿地；住房特征；以及空气污染。对每种 4 种城市化类型都拟合了多层次线性模型，以评估关联，同时调整了人口和社会特征。
老旧住房（建于 1979 年之前）和空气污染是所有城市化梯度下预期寿命差异的重要建成环境预测因素。便利店与所有城市化类型的预期寿命呈负相关。健康食品选择仅在高密度城市地区与预期寿命呈正相关。公园可达性与所有地区的预期寿命增加相关，除了农村地区。邻里绿地与城市地区的预期寿命呈正相关，但在农村地区呈相反的关联。
在调整了关键社会特征后，建成环境的几个特征是美国预期寿命降低的显著风险因素，其中一些措施的影响因城市化程度而异。规划和政策工作应根据当地情况进行调整。
