Research On The Influence Mechanism Of Urban Environment On Chronic Diseases And Its Action Path

Global rapid urbanization and economic growth have caused a series of negative impacts on the living environment and behavior of urban residents.Chronic diseases such as hypertension,asthma,and obesity have become new urban epidemics that seriously threaten the health of residents.Existing studies have proved that healthy city construction can reduce the threat of chronic diseases by improving the urban environment.In the context of implementing the national strategy of "Healthy China" and the improvement of residents’ health awareness,exploring the important factors behind the environment and chronic risks and a comprehensive understanding of the internal relationship between the two will help promote public health from the perspective of active intervention.However,the impact of the urban environment on health outcomes is more complex.Previous correlation studies did not consider the spatial non-stationarity of specific environmental elements,and less attention was paid to the role of social background.In addition,there is no exploration and verification of the impact path of the environment on health outcomes through intermediary factors such as residents’ behavior.This study first measures and processes the prevalence of chronic diseases in New York City,related urban environmental elements,and residents’ behavior activity,and provides index system support for subsequent empirical evidence through the construction of a multi-source database.Second,analyze the spatial pattern and clustering characteristics of chronic diseases and the natural environment,built environment,and social environment to identify the heterogeneity of residents’ chronic risk distribution,material space,and development background of each district.On this basis,the multiple linear regression and the MGWR model are further constructed to extract the significant environmental factors affecting the four chronic diseases,the environmental impact mechanism is robustly analyzed,and local regression coefficients are used to formulate countermeasures according to local conditions.Finally,based on the multiple mediation and chain mediation model,the behavioral activity path(physical activity,preventive treatment,unhealthy behavior,adaptive ability)of environmental impact comprehensive chronic risk is verified,and the total conduction path of environmental and health outcomes is clarified and optimized by using structural equation model.This study demonstrates that:(1)The urban environment has a significant positive and negative impact on the prevalence of chronic diseases,even if the social background variables are controlled,the conclusion still holds.Income level,private car ownership,and race in the social environment are the dominant influencing factors of chronic diseases,while winter LST in the natural environment,industry mix and building density in the built environment also have a strong impact on chronic diseases.(2)Higher building density,employment and household mix,industry mix,and income level have a positive mitigation effect on chronic diseases,while black or African-American households and the proportion of households with more than 2 cars are positively associated with chronic diseases;Winter LST,accessibility to eating space,accessibility to infrastructure,and proportion of carfree households are beneficial to reduce the prevalence of asthma and obesity;slope and hypertension and asthma,walking index and obesity,and proportion of poor English ability and asthma,the effects of the three groups are all positively correlated,while the impact of land use mix on hypertension is negatively correlated.(3)The relationship between the urban environment and chronic diseases presents significant spatial non-stationary characteristics.The MGWR model can reveal the optimal scale(bandwidth)of specific environmental elements on chronic diseases,and 79.1% to 92.2% of the prevalence of chronic diseases can be explained by this model.Among the factors affecting hypertension,the local scale is the smallest in terms of the industry mix(56),the high-income level(56)is the most sensitive to the impact on asthma,and the scale of building density(58)is the smallest among the factors affecting obesity.(4)Behavior activity is an important pathway through which the urban environment affects chronic diseases.Building density,land use mix,and employment and household mix can indirectly affect the prevalence of hypertension through behavior activity(walking index,preventive treatment,unhealthy behavior,and high-income level).Winter LST and building density can indirectly intervene in the prevalence of asthma through behavioral activities(walking to work,preventive treatment,and non-health behaviors).Building density,transportation station accessibility,infrastructure accessibility,dining space accessibility,and industry mix indirectly affect the prevalence of obesity through behavioral activities(walking to work,on-time physical examination,unhealthy behavior,high education level).(5)Behavior activity has a partial mediating effect between urban environment and chronic diseases(hypertension,asthma,obesity),and chronic diseases also have a partial mediating effect between behavioral activities and comprehensive chronic risk.Meanwhile,behavior activity and obesity play a chain mediating role between urban environment and hypertension.Based on the test results of the above mediating effects,the structural equation model was used to fit the path model of environmental intervention health outcomes: building density/industry mix/dining space accessibility/infrastructure accessibility→lack of exercise/lack of sleep→obesity→hypertension→comprehensive chronic risk.Healthy urban planning can suppress chronic risks from the perspective of optimizing the urban environment.While improving urban physical space,it also creates conditions for the occurrence of healthy behavior activity that play a mediating role.In addition to traditional built space construction and optimization,health-oriented green space,facility equity,and neighborhood community creation also have practical value.