Built environment and schizophrenia re-hospitalization risk in China: A cohort study

危险系数 比例危险模型 置信区间 精神分裂症(面向对象编程) 医学 环境卫生 可行走性 人口 Lasso(编程语言) 生态学研究 回归分析 人口学 统计 精神科 内科学 物理疗法 计算机科学 体力活动 社会学 万维网 数学
作者
Jian Song,Yunfeng Liang,Zhiwei Xu,Yudong Wu,Shuangshuang Yan,Lu Mei,Xiaoni Sun,Yuxuan Li,Xiaoyu Jin,Weizhuo Yi,Rubing Pan,Jian Cheng,Wenbiao Hu,Hong Su
出处
期刊:Environmental Research [Elsevier]
卷期号:227: 115816-115816 被引量:5
标识
DOI:10.1016/j.envres.2023.115816
摘要

Built environment exposure, characterized by ubiquity and changeability, has the potential to be the prospective target of public health policy. However, little research has been conducted to explore its impact on schizophrenia. This study aimed to investigate the association between built environmentand and schizophrenia rehospitalization by simultaneously considering substantial built environmental exposures. We recruited eligible schizophrenia patients from Hefei, Anhui Province, China between 2017 and 2019. The main outcome for this study was the time interval until the first recurrent hospital admission occurred within one year after discharge. For each included subject, we estimated the built environment exposures, including population density, walkability, land use mix, green and blue space, public transportation accessibility and road traffic indicator. Lasso (Least Absolute Shrinkage and Selection Operator) analysis was used to select the key variables. Multivariable Cox regression model was applied to obtain hazard ratio (HR) and its corresponding 95% confidence intervals (CI). Further, we also evaluated the joint effects of built environment characteristics on rehospitalization for schizophrenia by Quantile g-computation model. A total of 1564 hospitalized schizophrenia patients were enrolled, with 347 patients (22.2%) had a rehospitalization within one-year after discharge. Multivariable Cox regression analysis indicated that the re-hospitalization rate for schizophrenia would be higher in areas with a high population density (HR: 1.10, 95%CI: 1.04–1.16). Nonetheless, compared to the reference (Q1), participants who lived in a neighborhood with the highest walkability and NDVI (Normalized Difference Vegetation Index) (Q4) had a 76% and 47% lower risk of re-hospitalization within one year (HR:0.24, 95%CI: 0.13–0.45; and 0.53, 95%CI:0.32–0.85), respectively. Moreover, quantile-based g-computation analyses revealed that increased walkability and green space significantly eliminated the adverse effects of population density increases on schizophrenia patients, with a HR ratio of 0.61 (95%CI:0.48,0.79) per one quartile change at the same time. Our study provides scientific evidence for the significant role of built environment in schizophrenia rehospitalization, suggesting that optimizing the built environment is required in designing and building a healthy city.
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