Healthy Cities

Background The availability of physical activity (PA) facilities in neighborhoods is hypothesized to infuence cardiovascular disease (CVD), but evidence from individual-level long-term cohort studies is limited. We aimed to assess the association between neighborhood exposure to PA facilities and CVD incidence.

Methods A total of 4658 participants from the Chinese Multi-provincial Cohort Study without CVD at baseline (2007–2008) were followed for the incidence of CVD, coronary heart disease (CHD), and stroke. Availability of PA facilities was defned as both the presence and the density of PA facilities within a 500-m bufer zone around the participants' residential addresses. Time-dependent Cox regression models were performed to estimate the associations between the availability of PA facilities and risks of incident CVD, CHD, and stroke.

Results During a median follow-up of 12.1 years, there were 518 CVD events, 188 CHD events, and 355 stroke events.  Analyses with the presence indicator revealed signifcantly lower risks of CVD (hazard ratio [HR] 0.80, 95% confdence interval ([CI] 0.65–0.99) and stroke (HR 0.76, 95% CI 0.60–0.97) in participants with PA facilities in the 500-m bufer zone compared with participants with no nearby facilities in fully adjusted models. In analyses with the density indicator, exposure to 2 and≥3 PA facilities was associated with 35% (HR 0.65, 95% CI 0.47–0.91) and 28% (HR 0.72, 95% CI 0.56–0.92) lower risks of CVD and 40% (HR 0.60, 95% CI 0.40–0.90) and 38% (HR 0.62, 95% CI 0.46–0.84) lower risks of stroke compared with those without any PA facilities in 500-m bufer, respectively. Efect modifcations between presence of PA facilities and a history of hypertension for incident stroke (P=0.049), and a history of diabetes for incident CVD (P=0.013) and stroke (P=0.009) were noted.

Conclusions Residing in neighborhoods with better availability of PA facilities was associated with a lower risk of incident CVD. Urban planning intervention policies that increase the availability of PA facilities could contribute to CVD prevention.

BACKGROUND: Little is known about geographic variation in acute myocardial infarction (AMI) mortality within fast-developing megacities and whether changes in health care accessibility correspond to changes in AMI mortality at the small-area level.

METHODS AND RESULTS: We included data of 94106 AMI deaths during 2007 to 2018 from the Beijing Cardiovascular Disease Surveillance System in this ecological study. We estimated AMI mortality for 307 townships during consecutive 3-year periods with a Bayesian spatial model. Township-level health care accessibility was measured using an enhanced 2-step floating catchment area method. Linear regression models were used to examine the association between health care accessibility and AMI mortality. During 2007 to 2018, median AMI mortality in townships declined from 86.3 (95% CI, 34.2–173.8) to 49.4 (95% CI, 30.5–73.7) per 100000 population. The decrease in AMI mortality was larger in townships where health care accessibility increased more rapidly. Geographic inequality, defined as the ratio of the 90th to 10th percentile of mortality in townships, increased from 3.4 to 3.8. In total, 86.3% (265/307) of townships had an increase in health care accessibility. Each 10% increase in health care accessibility was associated with a −0.71% (95% CI, −1.08% to −0.33%) change in AMI mortality.

CONCLUSIONS: Geographic disparities in AMI mortality among Beijing townships are large and increasing. A relative increase in township-level health care accessibility is associated with a relative decrease in AMI mortality. Targeted improvement of health care accessibility in areas with high AMI mortality may help reduce AMI burden and improve its geographic inequality in megacities.

Methods: Recurrent AMI was identified by the Beijing Monitoring System for Cardiovascular Diseases through the end of 2019 for patients discharged with AMI between 2007 and 2017. Cox proportional hazards models were performed to estimate associations between neighborhood disorder and AMI recurrence.

Results: Of 66,238 AMI patients, 11,872 had a recurrent event, and 3117 died from AMI during a median followup of 5.92 years. After covariate adjustment, AMI patients living in the high tertile of neighborhood disorder had a higher recurrence risk (hazard ratio [HR] 1.08, 95 % confidence interval [CI], 1.03–1.14) compared with those in the low tertile. A stronger association was noted for fatal recurrent AMI (HR 1.21, 95 % CI 1.10–1.34). The association was mainly observed in females (HR 1.04, 95 % CI: 1.02 to 1.06).

Conclusions: Serious neighborhood disorder may contribute to higher recurrence risk, particularly fatal recurrence, among AMI patients. Policies to eliminate neighborhood disorders may play an important role in the secondary prevention of cardiovascular disease. 

This study has three main findings: 1) the overall medical accessibility of residential areas in Beijing is good. When patients suffer from acute myocardial infarction, they can reach the nearest hospital capable of performing Percutaneous Coronary Intervention surgery within 120 minutes of the golden treatment time. However, at different times, medical accessibility shows significant differences. Medical accessibility during the rush hour (7:00-9:00) is the worst, while medical accessibility at 0:00-7:00 is the best. In addition, the urban medical treatment spatial pattern has obvious spatial differentiation and aggregation characteristics. The accessibility in the peripheral areas is significantly different from that in the central urban area, where the accessibility in the area within the Fifth Ring Road is far better than that outside the Fifth Ring Road. Some areas in the southwest and north of Beijing have poor accessibility. Furthermore, the population within the Fifth Ring Road has more medical resources than that outside the Fifth Ring Road, while it is the opposite for the access to medical resources. There is a certain degree of mismatch between the population and medical resources inside and outside the Fifth Ring Road. 2) The layout of medical resources is somewhat unfair, and spatial deprivation of deprived groups appears. Specifically, the higher the average years of education and family income, the better the medical accessibility, while the longer it takes for people engaged in blue-collar work to reach medical facilities. Among these factors, the average years of education has the strongest explanatory power, and both the average years of education and family income have a double-factor enhancement effect on medical accessibility. 

elevated AMI fatality risk. These findings may help guide the allocation of health resources.

In recent years, pandemics have become one of the most significant challenges due to their huge socio-economic  impacts. Fortunately, smart technologies have provided new ideas to fight against them. Many studies have focused  on analyzing particular technologies applied in pandemics, but few have systematically discussed the difference and the relationship among multiple perspectives. China is well represented in the development of technologies and pandemic responses. Therefore, this paper uses China’s response to COVID-19 as an empirical study to systematically review the application of smart technologies and build a case base from multiple perspectives. A total of 1,102 cases from 14 technologies were collected from January 2020 to June 2020 after screening, and a series of analyses were conducted in terms of types, scales, stages, and targets. The result shows various subjects participated in pandemic responses using smart technologies. General technologies such as Big Data and Mobile Internet are most widely used. Besides, most technologies are used on the country or district/city scales and focus on the prevention and control of pandemics. There are significant differences in the penetration of technologies among different perspectives. We hope to provide a reference for applying smart technologies against pandemics in the future.

Background

With rapid urbanization, the urban environment, especially the neighborhood environment, has received increasing global attention. However, a comprehensive overview of the association between neighborhood risk factors and human health remains unclear due to the large number of neighborhood risk factor–human health outcome pairs.

Method

On the basis of a whole year of panel discussions, we first obtained a list of 5 neighborhood domains, containing 33 uniformly defined neighborhood risk factors. We only focused on neighborhood infrastructure-related risk factors with the potential for spatial interventions through urban design tools. Subsequently, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic meta-review of 17 infrastructure-related risk factors of the 33 neighborhood risk factors (e.g., green and blue spaces, proximity to major roads, and proximity to landfills) was conducted using four databases, Web of Science, PubMed, OVID, and Cochrane Library, from January 2000 to May 2021, and corresponding evidence for non-communicable diseases (NCDs) was synthesized. The review quality was assessed according to the A MeaSurement Tool to Assess Systematic Reviews (AMSTAR) standard.

Results

Thirty-three moderate-and high-quality reviews were included in the analysis. Thirteen major NCD outcomes were found to be associated with neighborhood infrastructure-related risk factors. Green and blue spaces or walkability had protective effects on human health. In contrast, proximity to major roads, industry, and landfills posed serious threats to human health. Inconsistent results were obtained for four neighborhood risk factors: facilities for physical and leisure activities, accessibility to infrastructure providing unhealthy food, proximity to industry, and proximity to major roads.

Conclusions

This meta-review presents a comprehensive overview of the effects of neighborhood infrastructure-related risk factors on NCDs. Findings on the risk factors with strong evidence can help improve healthy city guidelines and promote urban sustainability. In addition, the unknown or uncertain association between many neighborhood risk factors and certain types of NCDs requires further research.

Objectives: To assess overall and gender-specific associations between marital status and out-of-hospital coronary death (OHCD) compared with patients surviving to hospital admission.

Design: A cross-sectional study based on linkage of administrative health databases.

Setting: Beijing, China.

Participants: From 2007 to 2019, 378 883 patients with acute coronary event were identified in the Beijing Monitoring System for Cardiovascular Diseases, a validated city-wide registration system based on individual linkage of vital registration and hospital discharge data.

Outcome measures: OHCD was defined as coronary death occurring before admission. Multilevel modified Poisson regression models were used to calculate the prevalence ratios (PR) and 95% CIs.

Results: Among 378 883 acute coronary events, OHCD accounted for 33.8%, with a higher proportion in women compared with men (41.5% vs 28.7%, p<0.001). Not being married was associated with a higher proportion of OHCD in both genders, with a stronger association in women (PR 2.18, 95% CI 2.10 to 2.26) than in men (PR 1.97, 95% CI 1.91 to 2.02; p for interaction <0.001). The associations of OHCD with never being married (PR 1.98, 95% CI 1.88 to 2.08) and being divorced (PR 2.54, 95% CI 2.42 to 2.67) were stronger in men than in women (never married: PR 0.98, 95% CI 0.82 to 1.16; divorced: PR 1.47, 95% CI 1.34 to 1.61) (p for interaction <0.001 for both). Being widowed was associated with a higher proportion of OHCD in both genders, with a stronger association in women (PR 2.26, 95% CI 2.17 to 2.35) compared with men (PR 1.89, 95% CI 1.84 to 1.95) (p for interaction <0.001).

Conclusions: Not being married was independently associated with a higher proportion of OHCD and the associations differed by gender. Our study may aid the development of gender-specific public health interventions in high-risk populations characterised by marital status to reduce OHCD burden.

Background: Chinese people on average consume almost twice as much salt as recommended by the World Health Organization. In recent years, dining out and ordering food online are increasingly popular, especially for urban residents. The aim of this study is to evaluate the effectiveness of different settings on a digital food delivery App in nudging consumers towards reduced salt options through a randomized controlled trial in China.

Methods and Analysis: This is a randomized controlled trial with matched restaurants randomized to five parallel intervention groups plus a control group. Participating restaurants are recruited via open invitation and targeted invitation on a voluntary basis and are free to withdraw from the study at anytime. Each enrolled restaurant can select 1-3 of their most popular dishes to participate in this study. The recruitment ends at the end of June 2021. As of June 30, 285 restaurants enrolled for intervention groups and successfully completed interface set-up requirements. The primary outcome of this study is to investigate the differences in customer ordering behaviors regarding salt preference that result from changing the default settings and/or in combination with health messages before placing the order. The primary outcome will be measured by the difference between the number of regular salt orders and the number of reduced salt orders amongst the five intervention groups, and between each intervention group and the control group. We will collect order data at the end of the 2-month study period from the food delivery App. The secondary outcome is to measure if reduced the salt version of the participating dishes has less salt content than the regular version. The secondary outcome will be measured by lab testing salt content of randomly sampled dishes during the study period. In addition, we will also conduct pre- and post- intervention surveys with participating restaurants to assess their knowledge, attitude, and practice regarding salt reduction, and their perceptions on how such intervention affects their business, if at all. We will not include findings from the pre- and post-intervention interviews as an outcome but will use them to inform future restaurantbased salt reduction promotions.

Discussion: The study will test whether changing in the choice architecture on the digital food ordering platform will promote healthier ordering behavior among consumers. Results on whether user interface modifications can promote purchases of reduced salt dishes may provide evidence to inform future sodium reduction strategies and health promotion interventions on online food ordering platforms, with the potential to apply to offline dining settings. The results may also inform current government efforts to roll out national guidelines on promoting nutrition labeling by restaurants. Despite these strengths in study design, securing the agreement of the food delivery App, recruiting individual restaurants and maintaining compliance to the interface set up through the period of the study proved to be and remains challenging.

Neighborhoods are places where people spend the most time in their lives. Neighborhoods have a decisive impact on the residents' health. With several important tasks, including the transformation of old neighborhoods, the maintenance of existing neighborhoods, and the construction of new neighborhoods in the future, a scientific and reasonable evaluation standard is urgently needed to guide the development of healthy neighborhoods. To build the evaluation system, this paper first clarifies the principles for selecting evaluation indicators, which include: 1) the indicators are selected from a humanistic perspective; 2) the pathways between neighborhoods environment and health outcomes are deeply considered; 3) the indicators are selected from multiple scales. Secondly, based on the combined perspectives of urban planning and public health, it identifies the indicators that affect the residents' health in neighborhoods and searches the literature through the quality assessment to provide evidence to support the accuracy and effectiveness of the indicators. Finally, it proposes prospect to the evaluation, including 1) it is urgent to improve and utilize the healthy neighborhoods based on the Chinese condition; 2) advanced technologies need to be widely applied in neighborhoods in the future; 3) the transitions in cities should be considered in the future development of neighborhoods. It hopes that relevant researchers and government leaders to realize the importance and urgency of healthy neighborhoods to build more healthy neighborhoods in China.

Details are available HERE. 

As the increased attention to human settlements and healthy environment from all over the world, ‘healthy cities’ has become one of the most indispensable topics for urban development. Under such circumstance and the concept of “Health China” proposed in 2016, there has been an increasingly concern on the policy of urban tobacco and smoking control. In 2018, the World Health Organization started to focus on “smoking in cities” problem. In this study, WHO China cooperated with the Baidu Big Data department and Tsinghua University to conduct the spatial analysis and statistics research on the situation of urban smokers and the effects of tobacco control policy in China.

We evaluated people’s change of attention for tobacco-related information by using the massive and spatiotemporal query data and user profile data related to smoking problem in 2013 and 2017 offered by Baidu Big Data department. The data covered 2869 urban districts in China. Besides, we assessed the effects of tobacco control policies in Chinese cities based on the tobacco control policies of various cities. The results showed that there has been an increase in people’s awareness and discussion on the legislative content of smoke-free and the areas with high overall smoking attention were concentrated in the Yangtze River Basin. Meanwhile, the significant increase of people’s attention to e-cigarettes and tobacco tax policy was also found. As for the smoker groups, the proportion of smokers under 24 years old, female smokers and smokers with lower education level increased. We further compared the difference between cities with different levels of tobacco control policies and the results revealed the increase in overall attention on smoking in cities with strict smoking restrict policies. In addition, the attention of smoke-free and cessation increased in cities with smoking restrict policies and especially in those with strict smoking restrict policies. Furthermore, as the area with increasing smoke-free attention were obviously scattered around cities with strict smoking restrict policies, we found the policy may exert influence to surrounding area.

Tsinghua University:

Ying Long, Zhaoxi Zhang (Presenter), Jue Ma, Yuyang Zhang

Baidu Big Data Department:

Jidong Peng, Peng Liu, Shengwen Yang, Lu Meng, Xin Mao, Huadong Li

We thank Gauden GALEA, Xiaopeng JIANG, Kelvin Khow Chuan HENG, Paige SNIDER, Jiani SUN and Xi YIN (in the alphabetic order) from WHO China for their regular inputs and technical discussions.