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Assessing the Built Environment Through Photographs and Its Association With Obesity in 21 Countries: The Pure Study Publisher Pubmed



Corsi DJ1 ; Marschner S2 ; Lear S3 ; Hystad P4 ; Rosengren A5 ; Ismail R6 ; Yeates K7 ; Swaminathan S8 ; Puoane T9 ; Wang C10 ; Li Y10 ; Rangarajan S11 ; Kruger IM12 ; Chifamba J13 Show All Authors
Authors
  1. Corsi DJ1
  2. Marschner S2
  3. Lear S3
  4. Hystad P4
  5. Rosengren A5
  6. Ismail R6
  7. Yeates K7
  8. Swaminathan S8
  9. Puoane T9
  10. Wang C10
  11. Li Y10
  12. Rangarajan S11
  13. Kruger IM12
  14. Chifamba J13
  15. Vidhu Kumar K14
  16. Mohan I15
  17. Davletov K16
  18. Artamonov G17
  19. Palileovillanueva LM18
  20. Matnasir N19
  21. Zatonska K20
  22. Oguz A21
  23. Bahonar A22
  24. Alhabib KF23
  25. Yusufali A24
  26. Lopezjaramillo P25
  27. Lanas F26
  28. Galatte A27
  29. Avezum A28
  30. Mckee M29
  31. Yusuf S11
  32. Chow CK2
Show Affiliations
Authors Affiliations
  1. 1. School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
  2. 2. Westmead Applied Research Centre, Faculty of Medicine & Health, The University of Sydney, Westmead, NSW, Australia
  3. 3. Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
  4. 4. School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
  5. 5. Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
  6. 6. Department of Community Health, Faculty of Medicine, University Kebangsaan Malaysia, Bangi, Malaysia
  7. 7. Department of Medicine, Queen's University, Belfast, United Kingdom
  8. 8. St John's Research Institute, Bangalore, India
  9. 9. School of Public Health, University of the Western Cape, Cape Town, South Africa
  10. 10. Medical Research and Biometrics Center, National Center for Cardiovascular Disease, Fuwai Hospital, Beijing, China
  11. 11. Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
  12. 12. Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
  13. 13. Department of Biomedical Sciences, University of Zimbabwe, Harare, Zimbabwe
  14. 14. Health Action by People, Kerala, India
  15. 15. Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, India
  16. 16. Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
  17. 17. Federal State Budgetary Institution Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation
  18. 18. UP College of Medicine, University of the Philippines Manila, Manila, Philippines
  19. 19. Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Selangor, Malaysia
  20. 20. Department of Population Health, Wroclaw Medical University, Wroclaw, Poland
  21. 21. Department of Internal Medicine, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkiye
  22. 22. Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
  23. 23. Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud Medical City, King Saud University, Riyadh, Saudi Arabia
  24. 24. Tamani Foundation, Zanzibar, Tanzania
  25. 25. Masira Research Institute, Universidad de Santander, Bucaramanga, Colombia
  26. 26. Universidad de La Frontera, Temuco, Chile
  27. 27. ECLA, Santa Fe, Rosario, Argentina
  28. 28. International Research Center, Hospital Alemao Oswaldo Cruz, Sao Paulo, Brazil
  29. 29. London School of Hygiene & Tropical Medicine, London, United Kingdom

Source: The Lancet Global Health Published:2024


Abstract

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: Photographs were acquired with a standardised approach. We used the previously validated Environmental Profile of a Community's Health photo instrument to evaluate photos for safety, walkability, neighbourhood beautification, and community disorder. An integrated built environment score (ie, a minimum of 0 and a maximum of 20) was used to summarise this evaluation across built environment domains. Associations between built environment characteristics, separately and combined in the integrated built environment score, and obesity (ie, a BMI >30kg/m2) 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. © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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