美国退伍军人心血管疾病的建筑环境和不良心血管事件

IF 8 1区环境科学与生态学 Q1 ENVIRONMENTAL SCIENCES

Science of the Total Environment Pub Date : 2025-05-03 DOI:10.1016/j.scitotenv.2025.179596

Skanda Moorthy , Zhuo Chen , Tong Zhang , Sai Rahul Ponnana , Santosh Kumar Sirasapalli , Kanimozhi Shivanantham , Haitham Khraishah , Jean-Eudes Dazard , Sadeer G. Al-Kindi , Salil V. Deo , Sanjay Rajagopalan

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引用次数: 0

摘要

人工智能提取的可解释的建筑环境特征能否预测国家退伍军人人群的主要不良心血管事件（MACE）？在这项对770,990名美国退伍军人的队列研究中，七个建筑环境特征与MACE风险增加显著相关。两个特征，旧/破旧的建筑和可见的电线，与降低风险有关。绿色植物只与社会剥夺指数较高的四分位数的风险增加有关。意义建成环境特征可以作为MACE的预测因子，突出了社区特征在心血管危险分层中的潜在作用，超越了传统因素。建筑环境特征与动脉粥样硬化性心血管疾病（ASCVD）患者主要不良心血管事件（MACE）之间的关系仍未得到充分研究。我们的研究旨在发现哪些特定的建筑环境特征影响心血管死亡率。美国退伍军人（2016-2021）（98%男性，86%白人）稳定ASCVD（冠状动脉疾病、脑血管疾病或外周动脉疾病）的回顾性队列研究。使用美国每隔50米采样的1.64亿桶街景图像（2019年）来评估建筑环境特征。包括绿化、人行道和非单户住宅在内的11个特征被分析为包含每个元素的图像的百分比。这些数据在人口普查区进行汇总，并通过居住地址与参与者的医疗保健数据相关联。主要终点为首次MACE发生（非致死性心肌梗死、非致死性卒中或心血管死亡率）。使用多变量细灰色模型分析关联，调整人口统计学、临床因素、社会剥夺指数和竞争风险。结果在4年的中位随访中，与MACE风险增加相关的特征包括绿地（亚hr: 1.054, 95% CI: 1.047-1.061）、单车道道路（亚hr: 1.059, 95% CI: 1.054 - 1.065）、人行道（亚hr: 1.023, 95% CI: 1.020-1.026）、人行横道（亚hr: 1.062, 95% CI: 1.040-1.083）、非单户住宅（亚hr: 1.088, 95% CI: 1.083-1.094）和两辆或更多汽车（亚hr: 1.013, 95% CI: 1.006-1.019）。与较低MACE风险相关的特征包括旧建筑（subHR: 0.976, 95% CI: 0.971-0.982）和可见布线（subHR: 0.972, 95% CI: 0.967-0.976）。结论建筑环境特征影响美国ASCVD退伍军人MACE风险，强调暴露物在心血管健康中的作用。

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The built environment and adverse cardiovascular events in US veterans with cardiovascular disease

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The built environment and adverse cardiovascular events in US veterans with cardiovascular disease

Question

Can AI-extracted interpretable built environment features predict major adverse cardiovascular events (MACE) in a national veteran population?

Findings

In this cohort study of 770,990 U.S. veterans, seven built environment features were significantly associated with an increased risk of MACE. Two features, old/dilapidated buildings and visible wire, were associated with a decreased risk. Greenery was only linked to increased risk in higher social deprivation index quartiles.

Meaning

Built environment features can serve as predictors of MACE, highlighting the potential role of neighborhood characteristics in cardiovascular risk stratification beyond traditional factors.

Importance

The relationship between built environment features and major adverse cardiovascular events (MACE) in patients with atherosclerotic cardiovascular disease (ASCVD) remains understudied. Our study aims to discover what specific built environmental features influence cardiovascular mortality.

Design

Retrospective cohort study of US Veterans (2016–2021) (98 % male, 86 % white) with stable ASCVD (coronary artery disease, cerebrovascular disease, or peripheral artery disease).

Exposures

Built environment features were assessed using 164 million Google Street View images (2019) sampled every 50 m across the US. Eleven features, including greenery, sidewalks, and non-single-family homes, were analyzed as the percentage of images containing each element. These were summarized at the census tract level and linked to participant healthcare data via residential addresses.

Outcome

The primary outcome was first MACE occurrence (non-fatal myocardial infarction, non-fatal stroke, or cardiovascular mortality). Associations were analyzed using multivariable Fine Gray models, adjusting for demographics, clinical factors, the social deprivation index, and competing risks.

Results

Over a 4-year median follow-up, features associated with increased MACE risk included greenery (subHR: 1.054, 95 % CI: 1.047–1.061), single-lane roads (subHR: 1.059, 95 % CI: 1.054–1.065), sidewalks (subHR: 1.023, 95 % CI: 1.020–1.026), crosswalks (subHR: 1.062, 95 % CI: 1.040–1.083), non-single-family homes (subHR: 1.088, 95 % CI: 1.083–1.094), and two or more cars (subHR: 1.013, 95 % CI: 1.006–1.019). Features linked to lower MACE risk included old buildings (subHR: 0.976, 95 % CI: 0.971–0.982) and visible wiring (subHR: 0.972, 95 % CI: 0.967–0.976).

Conclusions

Built environment features influence MACE risk in US Veterans with ASCVD, emphasizing the role of the exposome in cardiovascular health.

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来源期刊

Science of the Total Environment 环境科学-环境科学

CiteScore

17.60

自引率

10.20%

发文量

8726

审稿时长

2.4 months

期刊介绍： The Science of the Total Environment is an international journal dedicated to scientific research on the environment and its interaction with humanity. It covers a wide range of disciplines and seeks to publish innovative, hypothesis-driven, and impactful research that explores the entire environment, including the atmosphere, lithosphere, hydrosphere, biosphere, and anthroposphere. The journal's updated Aims & Scope emphasizes the importance of interdisciplinary environmental research with broad impact. Priority is given to studies that advance fundamental understanding and explore the interconnectedness of multiple environmental spheres. Field studies are preferred, while laboratory experiments must demonstrate significant methodological advancements or mechanistic insights with direct relevance to the environment.