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

作者：Daniel J. Corsi, Simone Marschner, Scott A. Lear, Perry Hystad, Annika Rosengren, Rosnah Ismail, Karen Yeates, Sumathi Swaminathan, Thandi Puoane, Chuangshi Wang, 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 López‐Jaramillo, Fernando Laņas, Agustina Galatte, Álvaro Avezum, Martin McKee, Salim Yusuf, Clara K Chow · 发表于：The Lancet Global Health · 年份：2024 · DOI：10.1016/s2214-109x(24)00287-0 · 被引用次数：8 · 研究领域：Urban Transport and Accessibility、Urban Green Space and Health、Injury Epidemiology and Prevention

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 increa...