Yang Teng, Wang Jiawei, Jin Jianbo, Hu Xin, Li Guoxing, Huang Jing
Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, Beijing, 100191, China.
Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, Beijing, 100191, China; Environmental Research Group, School of Public Health, Imperial College London, London, W12 0BZ, United Kingdom.
Environ Pollut. 2025 Jun 15;375:126316. doi: 10.1016/j.envpol.2025.126316. Epub 2025 Apr 25.
Residential green space has the potential to benefit cardiometabolic health. However, little is known about its impacts on cardiometabolic multimorbidity (CMM). Furthermore, the capacity of access to green space to reduce health inequalities during the development of CMM is unclear, and longitudinal evidence is urgently needed. Hence, a large prospective study based on the UK Biobank was conducted. CMM was defined as the coexistence of at least two conditions including type 2 diabetes, ischemic heart disease, and stroke. Multi-state models were used to assess the impacts of green space on the transitions of CMM, from free of cardiometabolic disease to first cardiometabolic disease (FCMD), subsequently to CMM, and finally death. This study included 328,260 participants with a median follow-up of 12.5 years. The benefits of access to green space were observed for transitions from baseline to FCMD, from baseline to death, and from FCMD to death, with HRs of 0.975 (95 % CI: 0.959, 0.991), 0.956 (95 % CI: 0.931, 0.982) and 0.943 (95 % CI: 0.897, 0.990) per IQR increase in the percentage of green space, respectively. Although access to green space benefited early transitions related to FCMD, its protective role was not found in the progression from FCMD to CMM and finally death. Furthermore, access to green space was associated with a reduction in health inequalities influenced by sex and socioeconomic status in the earliest transition from healthy to FCMD. Future policies should prioritize green space investments to sustainably enhance cardiometabolic health and improve health inequalities.
居住绿地有可能有益于心脏代谢健康。然而，对于其对心脏代谢共病（CMM）的影响却知之甚少。此外，在CMM发展过程中，绿地可及性减少健康不平等的能力尚不清楚，迫切需要纵向证据。因此，基于英国生物银行开展了一项大型前瞻性研究。CMM被定义为至少两种疾病的共存，包括2型糖尿病、缺血性心脏病和中风。多状态模型用于评估绿地对CMM转变的影响，从无心脏代谢疾病到首次出现心脏代谢疾病（FCMD），随后到CMM，最后到死亡。本研究纳入了328260名参与者，中位随访时间为12.5年。在从基线到FCMD、从基线到死亡以及从FCMD到死亡的转变中，均观察到了绿地可及性的益处，每增加一个四分位间距的绿地百分比，风险比（HR）分别为0.975（95%置信区间：0.959，0.991）、0.956（95%置信区间：0.931，0.982）和0.943（95%置信区间：0.897，0.990）。尽管绿地可及性有利于与FCMD相关的早期转变，但在从FCMD到CMM以及最终死亡的进展过程中未发现其保护作用。此外，在从健康到FCMD的最早转变中，绿地可及性与受性别和社会经济地位影响的健康不平等减少相关。未来政策应优先考虑绿地投资，以可持续地改善心脏代谢健康并减少健康不平等。
