Assessing the built environment through photographs and its association with obesity in 21 countries: the PURE Study

Daniel J. Corsi, Simone L. Marschner, Scott Alexander Lear, Perry Hystad, Annika Rosengren, Rosnah Ismail, Karen Yeates, Sumathi Swaminathan, Thandi Rose Puoane, Chuangshi Wang

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Yang Li, Sumathy Rangarajan, Iolanthé M. Kruger, Jephat Chifamba, K Vidhu Kumar, Indu Mohan, Kairat Davletov, G. V. Artamonov, Lia M. Palileo‐Villanueva, Nafiza Mat Nasir, Katarzyna Zatońska, Aytekin Oğuz, Ahmad Bahonar, Khalid F. AlHabib, Afzalhussein Yusufali, Patricio A López-Jaramillo, Fernando Tomas Lanas, Agustina Galatte, Álvaro Avezum, Martin McKee, Salim Yusuf, Clara Kayei Chow

The Lancet Global Health, 2024

Полный текст Открытый доступ: Gold Метаданные (CSL-JSON)
DOI 10.1016/s2214-109x(24)00287-0
Достоверность данных 85 высокая
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Аннотация

BACKGROUND: The built environment can influence human health, but the available evidence is modest and almost entirely from urban communities in high-income countries. Here we aimed to analyse built environment characteristics and their associations with obesity in urban and rural communities in 21 countries at different development levels participating in the Prospective Urban and Rural Epidemiology (PURE) Study. METHODS: ) were assessed using multilevel regression models, adjusting for individual, household, and community confounding factors. Attenuation in the associations due to walking was examined. FINDINGS: Analyses include 143 338 participants from 530 communities. The mean integrated built environment score was higher in high-income countries (13·3, SD 2·8) compared with other regions (10·1, 2·5) and urban communities (11·2, 3·0). More than 60% of high-income country communities had pedestrian safety features (eg, crosswalks, sidewalks, and traffic signals). Urban communities outside high-income countries had higher rates of sidewalks (176 [84%] of 209) than rural communities (59 [28%] of 209). 15 (5%) of 290 urban communities had bike lanes. Litter and graffiti were present in 372 (70%) of 530 communities, and poorly maintained buildings were present in 103 (19%) of 530. The integrated built environment score was significantly associated with reduced obesity overall (relative risk [RR] 0·58, 95% CI 0·35-0·93; p=0·025) for high compared with low scores and for increasing trend (0·85, 0·78-0·91; p<0·0001). The trends were statistically significant in urban (0·85, 0·77-0·93; p=0·0007) and rural (0·87, 0·78-0·97; p=0·015) communities. Some built environment features were associated with a lower prevalence of obesity: community beautification RR 0·75 (95% CI 0·61-0·92; p=0·0066); bike lanes RR 0·58 (0·45-0·73; p<0·0001); pedestrian safety RR 0·75 (0·62-0·90; p=0·0018); and traffic signals RR 0·68 (0·52-0·89; p=0·0055). Community disorder was associated with a higher prevalence of obesity (RR 1·48, 95% CI 1·17-1·86; p=0·0010). INTERPRETATION: Community built environment features recorded in photographs, including bike lanes, pedestrian safety measures, beautification, traffic density, and disorder, were related to obesity after adjusting for confounders, and stronger associations were found in urban than rural communities. The method presents a novel way of assessing the built environment's potential effect on health. FUNDING: Population Health Research Institute, Hamilton Health Sciences Research Institute, Heart and Stroke Foundation of Ontario, Canadian Institutes of Health Research's Strategy for Patient Oriented Research, Ontario Support Unit, Ontario Ministry of Health and Long-Term Care, AstraZeneca, Sanofi-Aventis, Boehringer Ingelheim, Servier, and GlaxoSmithKline.