Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, No.81 Meishan Road, Shushan District, Hefei, Anhui, 230031, China; Ecosystem Change and Population Health Research Group, School of Public Health and Social Work, Queensland University of Technology, Australia.
Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, No.81 Meishan Road, Shushan District, Hefei, Anhui, 230031, China.
Environ Res. 2023 Jun 15;227:115816. doi: 10.1016/j.envres.2023.115816. Epub 2023 Mar 31.
Built environment exposure, characterized by ubiquity and changeability, has the potential to be the prospective target of public health policy. However, little research has been conducted to explore its impact on schizophrenia. This study aimed to investigate the association between built environmentand and schizophrenia rehospitalization by simultaneously considering substantial built environmental exposures.
We recruited eligible schizophrenia patients from Hefei, Anhui Province, China between 2017 and 2019. The main outcome for this study was the time interval until the first recurrent hospital admission occurred within one year after discharge. For each included subject, we estimated the built environment exposures, including population density, walkability, land use mix, green and blue space, public transportation accessibility and road traffic indicator. Lasso (Least Absolute Shrinkage and Selection Operator) analysis was used to select the key variables. Multivariable Cox regression model was applied to obtain hazard ratio (HR) and its corresponding 95% confidence intervals (CI). Further, we also evaluated the joint effects of built environment characteristics on rehospitalization for schizophrenia by Quantile g-computation model.
A total of 1564 hospitalized schizophrenia patients were enrolled, with 347 patients (22.2%) had a rehospitalization within one-year after discharge. Multivariable Cox regression analysis indicated that the re-hospitalization rate for schizophrenia would be higher in areas with a high population density (HR: 1.10, 95%CI: 1.04-1.16). Nonetheless, compared to the reference (Q1), participants who lived in a neighborhood with the highest walkability and NDVI (Normalized Difference Vegetation Index) (Q4) had a 76% and 47% lower risk of re-hospitalization within one year (HR:0.24, 95%CI: 0.13-0.45; and 0.53, 95%CI:0.32-0.85), respectively. Moreover, quantile-based g-computation analyses revealed that increased walkability and green space significantly eliminated the adverse effects of population density increases on schizophrenia patients, with a HR ratio of 0.61 (95%CI:0.48,0.79) per one quartile change at the same time.
Our study provides scientific evidence for the significant role of built environment in schizophrenia rehospitalization, suggesting that optimizing the built environment is required in designing and building a healthy city.
建筑环境暴露具有普遍性和可变性，有可能成为公共卫生政策的前瞻性目标。然而，很少有研究探讨其对精神分裂症的影响。本研究旨在通过同时考虑大量的建筑环境暴露，探讨建筑环境与精神分裂症再入院之间的关系。
我们于 2017 年至 2019 年期间从中国安徽省合肥市招募了符合条件的精神分裂症患者。本研究的主要结局是从出院后一年内首次复发住院的时间间隔。对于每个纳入的研究对象，我们估计了建筑环境暴露，包括人口密度、步行性、土地利用混合度、绿地和蓝地、公共交通可达性和道路交通指标。使用套索（最小绝对收缩和选择算子）分析选择关键变量。多变量 Cox 回归模型用于获得危险比（HR）及其相应的 95%置信区间（CI）。此外，我们还通过定量 g 计算模型评估了建筑环境特征对精神分裂症再入院的联合效应。
共纳入 1564 例住院精神分裂症患者，其中 347 例（22.2%）在出院后一年内再次住院。多变量 Cox 回归分析表明，人口密度较高的地区精神分裂症再入院率较高（HR：1.10，95%CI：1.04-1.16）。然而，与参考值（Q1）相比，居住在步行性和 NDVI（归一化差异植被指数）最高的街区的参与者在一年内再次住院的风险分别降低了 76%和 47%（HR：0.24，95%CI：0.13-0.45；0.53，95%CI：0.32-0.85）。此外，基于分位数的 g 计算分析表明，步行性和绿地的增加显著消除了人口密度增加对精神分裂症患者的不利影响，相同时间内每增加一个四分位数，HR 比值为 0.61（95%CI：0.48，0.79）。
本研究为建筑环境在精神分裂症再入院中的重要作用提供了科学证据，表明在设计和建设健康城市时需要优化建筑环境。
