Associations of perceived built environment characteristics using NEWS questionnaires with all-cause mortality and major cardiovascular diseases: The prospective urban rural epidemiology (PURE)-China study

Mengya Li; Yang Li; Zhiguang Liu; Perry Hystad; Sumathy Rangarajan; Lap Ah Tse; Scott A Lear; Yuanting Ma; Mengxin Chen; Guoliang Han; Ruotong Li; Salim Yusuf; Lisheng Liu; Bo Hu; Wei Li; PURE-China Investigators

doi:10.1016/j.envint.2024.108627

Associations of perceived built environment characteristics using NEWS questionnaires with all-cause mortality and major cardiovascular diseases: The prospective urban rural epidemiology (PURE)-China study

Environ Int. 2024 Apr 13:187:108627. doi: 10.1016/j.envint.2024.108627. Online ahead of print.

Authors

Mengya Li¹, Yang Li², Zhiguang Liu³, Perry Hystad⁴, Sumathy Rangarajan⁵, Lap Ah Tse⁶, Scott A Lear⁷, Yuanting Ma⁸, Mengxin Chen¹, Guoliang Han¹, Ruotong Li¹, Salim Yusuf⁵, Lisheng Liu⁹, Bo Hu¹⁰, Wei Li¹¹; PURE-China Investigators

Affiliations

¹ Medical Research & Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences Beijing, China.
² Medical Research & Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences Beijing, China; Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
³ Clinical Trial Unit, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
⁴ School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States.
⁵ Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.
⁶ JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR.
⁷ Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada.
⁸ Dongguan Street Community Health Service Center, Xining, Qinghai Province, China.
⁹ Beijing Hypertension League Institute, Beijing, China. Electronic address: llsh_0723@126.com.
¹⁰ Medical Research & Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences Beijing, China. Electronic address: hubo@mrbc-nccd.com.
¹¹ Medical Research & Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences Beijing, China. Electronic address: liwei@mrbc-nccd.com.

PMID: 38636273
DOI: 10.1016/j.envint.2024.108627

Abstract

Background: Despite increased literature focusing on the role of the built environment (BE) in health, few cohort studies have quantitatively analyzed neighborhood walkability environment in relation to the risk of death and cardiovascular disease (CVD). This longitudinal study aimed at evaluating the association between perceived BE attributeswith mortality and major CVD based on the Prospective Urban Rural Epidemiology study in China (PURE-China).

Methods: The PURE-China study recruited 47,931 participants aged 35-70 years from 12 provinces of China between 2005 and 2009. The perceived BE information, including land use, street, aesthetics, and safety, was collected using the neighborhood environment walkability scale (NEWS) questionnaire, with higher scores indicating a more favorable rating. Two primary outcomes are all-cause mortality and major CVD event. The Cox frailty model with random intercepts was used to assess the association between the perceived total BE/subscales score and outcomes.

Results: Of 32,163 participants included in this study, 19,253 (59.9 %) were women, and the mean (SD) age was 51.0 (9.5) years. After a median follow-up period of 11.7 years (IQR 9.4 - 12.2), we observed that one standard deviation higher of combined BE scores was related to a lower risk of all-cause mortality (HR = 0.85; 95 %CI, 0.80-0.90), and major CVD events (HR = 0.95; 95 %CI, 0.90-0.99). The subscales of perceived BE were related to a lower risk, although a few were not significant. Land use mix-diversity and safety from crime were the two most significant subscales. Stronger risks were observed among urban and female participants.

Conclusion: Favorable perceived BE characteristics were linked with a lower risk of all-cause mortality and major CVD events in Chinese population, especially in urban areas and females. Our findings can be used by policymakers to take action to mitigate the adverse effect of poor community conditions on health, such as improving local amenities and transport connectivity, providing building paths for walking, running and cycling.

Keywords: All-cause mortality; Built environment; Cardiovascular diseases; Cohort; Neighborhood environment walkability scale.