Du Zhen, Sato Koryu, Hino Kimihiro, Kondo Katsunori, Kondo Naoki
Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan.
Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan; Faculty of Policy Management, Keio University, Kanagawa, Japan.
Soc Sci Med. 2025 Jul;377:118093. doi: 10.1016/j.socscimed.2025.118093. Epub 2025 Apr 23.
Physical inactivity and social isolation are key obstacles to achieving healthy and active aging. This study evaluated the association between participation in a citywide economic incentive Yokohama Walking Point (YWP) program with walking time, the risk of being homebound, and social isolation. We also explored the heterogeneities in the association across gender, socioeconomic status (SES), and built environment (BE).
A prospective cohort study was conducted on 3,171 residents aged ≥65 years from the Japan Gerontological Evaluation Study. YWP participation status was confirmed in 2016, outcomes were measured in 2020, and covariates were obtained in 2013. Built environment variables were measured based on geographic information system. General linear regression and modified Poisson regression models were performed using doubly robust estimation with inverse probability of treatment weighting.
Participation in YWP was associated with an increase of 6.83 min per day of walking time, and a 21 % decreased risk of social isolation. The associations showed heterogeneity; participants with low income and those living near parks had lower risks of being homebound. Men, participants with low education levels, and those living in high population density areas exhibited lower risks of social isolation compared with their counterparts.
Participation in YWP was associated with improved physical and social activity. Gender, SES, and BE moderated these associations, highlighting their potential role in reducing social health disparity. These findings emphasized the need for integrated policy interventions incorporating program design and urban planning to create an age-friendly community fostering healthy and inclusive aging.
缺乏身体活动和社会隔离是实现健康和积极老龄化的关键障碍。本研究评估了参与全市范围的经济激励措施横滨步行积分（YWP）计划与步行时间、居家风险和社会隔离之间的关联。我们还探讨了这种关联在性别、社会经济地位（SES）和建成环境（BE）方面的异质性。
对来自日本老年学评估研究的3171名年龄≥65岁的居民进行了一项前瞻性队列研究。2016年确认YWP参与状况，2020年测量结果，2013年获取协变量。基于地理信息系统测量建成环境变量。使用具有治疗权重逆概率的双重稳健估计进行一般线性回归和修正泊松回归模型。
参与YWP与每天步行时间增加6.83分钟以及社会隔离风险降低21%相关。这些关联存在异质性；低收入参与者和居住在公园附近的人居家风险较低。与女性相比，男性、受教育程度低的参与者以及居住在人口高密度地区的人社会隔离风险较低。
参与YWP与身体和社会活动的改善相关。性别、SES和BE调节了这些关联，凸显了它们在减少社会健康差距方面的潜在作用。这些发现强调需要将项目设计和城市规划纳入综合政策干预措施，以创建一个促进健康和包容性老龄化的老年友好型社区。
