Wang Xiaowen, Gu Yongshi, Wang Ying, Qiu Yuqing, Chen Tianling, Hopke Philip K, Zhang Kai, Lin Shao, Qu Yanji, Lin Ziqiang, Deng Xinlei, Sun Jie, Zhu Shuming, Deng Xueqing, Li Sizhe, Lin Xian, Du Zhicheng, Hao Yuantao, Zhang Wangjian
Center for Public Health and Epidemic Preparedness & Response, School of Public Health, Peking University, Peking University, Beijing, 100191, China.
Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, 02115, USA.
BMC Med. 2025 Apr 18;23(1):228. doi: 10.1186/s12916-025-04060-8.
Environmental access to exercise opportunities plays a crucial role in determining the level of physical activity within a population. However, it is unclear how environmental factors contribute to disparities in physical activity and health outcomes. We explored the associations between county-level access to exercise opportunities and cardiovascular disease (CVD) mortality across US counties.
We conducted an ecological analysis using aggregated data from two primary sources: the County Health Rankings and Roadmaps data and CDC WONDER mortality data. We compared county-level age-adjusted CVD mortality across county-level quartiles of access to exercise opportunities and physical inactivity. Stratification was performed based on age, sex, race, and urbanization variables. The rate ratio (RR) for CVD mortality was also calculated using generalized linear models.
We observed significant variations in CVD mortality across different levels of exercise opportunities access and physical inactivity, which was consistent across all demographic subgroups (P < 0.001). Access to exercise opportunities was significantly associated with a reduced risk of CVD mortality (RR = 0.93 [0.91-0.95]), and the association was most pronounced for acute myocardial infarction (AMI) mortality (RR, 0.80 [0.76-0.85]). The county-level physical inactivity was significantly associated with an increased risk of CVD mortality (RR, 1.16 [1.14-1.17]), especially for ischemic heart disease (IHD) (RR, 1.35 [1.31-1.38]) and AMI (RR, 1.32 [1.25-1.38]). All demographic subgroups demonstrated similar benefits in reducing the risk of CVD by improving the county-level indicators of physical activity.
Counties have the potential to make significant environmental strides in improving the cardiovascular health of their populations by enhancing access to exercise opportunities in the context of urbanization.
环境中锻炼机会的可及性在决定人群身体活动水平方面起着关键作用。然而，尚不清楚环境因素如何导致身体活动和健康结果的差异。我们探讨了美国各县县级锻炼机会可及性与心血管疾病（CVD）死亡率之间的关联。
我们使用来自两个主要来源的汇总数据进行了一项生态分析：县健康排名与路线图数据以及美国疾病控制与预防中心（CDC）的奇迹死亡率数据。我们比较了锻炼机会可及性和身体不活动的县级四分位数中县级年龄调整后的CVD死亡率。根据年龄、性别、种族和城市化变量进行分层。还使用广义线性模型计算了CVD死亡率的率比（RR）。
我们观察到不同水平的锻炼机会可及性和身体不活动情况下CVD死亡率存在显著差异，所有人口亚组情况均一致（P < 0.001）。锻炼机会可及性与CVD死亡率风险降低显著相关（RR = 0.93 [0.91 - 0.95]），这种关联在急性心肌梗死（AMI）死亡率方面最为明显（RR，0.80 [0.76 - 0.85]）。县级身体不活动与CVD死亡率风险增加显著相关（RR，1.16 [1.14 - 1.17]），尤其是缺血性心脏病（IHD）（RR，1.35 [1.31 - 1.38]）和AMI（RR，1.32 [1.25 - 1.38]）。所有人口亚组通过改善县级身体活动指标在降低CVD风险方面都显示出类似的益处。
各县有潜力在城市化背景下通过增加锻炼机会可及性，在改善其人口心血管健康方面取得重大环境进展。
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