Association of neighborhood greenness exposure and diabetes mellitus among adults in Bengbu: the mediation of body mass index
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摘要:
目的 了解蚌埠市龙子湖区社区绿地暴露与糖尿病(diabetes mellitus, DM)患病率的相关性，并探讨BMI在社区绿地暴露与DM之间的中介效应。 方法 2015年8月，采用分层随机抽样，调查蚌埠市龙子湖区成年居民3 354人。居民基本信息以问卷形式收集，社区绿地暴露用归一化植被指数(normalized difference vegetation index，NDVI)和土壤调整植被指数(soil adjusted vegetation index，SAVI)1 000 m缓冲区的值表示。用二分类Logistic回归分析探究社区绿地暴露与DM的相关性，并评估BMI的中介效应。 结果 NDVI-1 000 m (χ2=36.39, P < 0.001)与SAVI-1 000 m(χ2=20.14, P < 0.001)不同组之间患病率均存在统计学差异。调整模型下，NDVI-1 000 m和SAVI-1 000 m Q3组患病率分别是Q1组的0.538倍(OR=0.538，95% CI: 0.388~0.745)和0.605倍(OR=0.605，95% CI: 0.440~0.833)。BMI在NDVI-1 000 m和SAVI-1 000 m与DM的关联分别存在6.42%(95% CI: 1.83%~16.00%)和7.43%(95% CI: 2.36%~19.00%)的中介效应。 结论 社区绿地暴露越高，DM患病率越低。BMI在社区绿地暴露与DM之间有中介效应。 -
关键词:
- 糖尿病 /
- 社区绿地暴露 /
- 中介效应 /
- 二分类Logistic回归分析
Abstract:Objective This study aims to evaluate the association between neighborhood greenness exposure and diabetes mellitus (DM) among adults in Longzihu District, Bengbu City, and to explore the mediating effect of BMI on neighborhood greenness exposure with DM. Methods In 2015, 3 354 adult residents in Longzihu District were recruited. Basic information was obtained by questionnaire survey. Normalized difference vegetation index (NDVI) and soil adjusted vegetation index (SAVI) values with 1000 m buffers were used to evaluate neighborhood greenness exposure. Binary Logistic regression was conducted to assess the association between neighborhood greenness exposure and DM. In addition, this study assessed the mediating effects of BMI on neighborhood greenness exposure with DM. Results There were significant differences in the prevalence of DM among different groups in NDVI-1 000m (χ2=36.39, P < 0.001) and SAVI-1 000m (χ2=20.14, P < 0.001). In the fully adjusted model, the prevalence of DM in the Q3 group was 0.538 (OR=0.538, 95% CI: 0.388-0.745) and 0.605 (OR=0.605, 95% CI: 0.440-0.833) compared to the Q1 group under NDVI-1 000 m and SAVI-1 000 m, respectively. The BMI mediated 6.42% (95% CI: 1.83%-16.00%) on NDVI-1 000m with DM and 7.43% (95% CI: 2.36%-19.00%) on SAVI-1 000 m with DM. Conclusion The higher the neighborhood greenness exposure, the lower the prevalence of DM. BMI was a mediating factor between neighborhood greenness exposure with DM. -
表 1 参与者基本特征[n (%)]
Table 1. Participant characteristics [n (%)]
变量 DM 非DM 总人数(N=3 354) χ2 P值 性别 9.81 0.002 男 184(12.5) 1 284(87.5) 1 468(43.8) 女 173(9.2) 1 713(90.8) 1 886(56.2) 年龄(岁) 117.10 < 0.001 18~＜45 9(1.6) 540(98.4) 549(16.4) 45~＜60 149(5.4) 1 681(94.6) 1 850(55.2) ≥60 179(18.7) 776(81.3) 955(28.5) BMI(kg/m2) 46.10 < 0.001 < 18.5 1(0.9) 106(99.1) 107(3.2) 18.5~＜24.0 105(7.7) 1 257(92.3) 1 362(40.6) 24.0~＜28.0 176(12.1) 1 273(87.9) 1 449(43.2) ≥28.0 75(17.2) 361(82.8) 436(13.0) 文化程度 14.40 < 0.001 小学及以下 136(13.8) 852(86.2) 988(29.5) 中学 190(9.4) 1 831(90.6) 2 021(60.3) 大专及以上 31(9.0) 314(91.0) 345(10.3) 婚姻 16.26 0.001 未婚 2(1.7) 118(98.3) 120(3.6) 已婚 299(10.5) 2 540(89.5) 2 839(84.6) 丧偶 48(14.9) 275(85.1) 323(9.6) 离异 8(11.1) 64(88.9) 72(2.1) 月收入(元) 15.27 < 0.001 0~＜1 000 63(8.1) 714(91.9) 777(23.2) 1 000~＜3 000 246(12.4) 1 743(87.6) 1 989(59.3) ≥3 000 48(8.2) 540(91.8) 588(17.5) DM家族史 125.38 < 0.001 无 247(8.4) 2 695(91.6) 2 942(87.7) 有 110(26.7) 302(73.3) 412(12.3) 吸烟 4.64 0.031 否 227(9.8) 2 078(90.2) 2 305(68.7) 是 130(12.4) 919(87.6) 1 049(31.3) 经常运动 13.76 < 0.001 否 142(8.6) 1 508(91.4) 1 650(49.2) 是 215(12.6) 1 489(87.4) 1 704(50.8) 
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表 2 社区绿地暴露与DM患病率分析[n (%)]
Table 2. Analysis on neighborhood greenness exposure and prevalence of DM [n (%)]
社区绿地暴露 x±s DM 非DM 总人数 χ2值 P值 NDVI-1 000 m 36.39 < 0.001 Q1组 0.259±0.130 142(12.3) 1 012(87.7) 1 154(34.4) Q2组 0.293±0.007 150(13.4) 971(86.6) 1 121(33.4) Q3组 0.481±0.165 65(6.0) 1 014(94.0) 1 079(32.2) SAVI-1 000 m 20.14 < 0.001 Q1组 0.156±0.014 144(12.6) 1 003(87.4) 1 147(34.2) Q2组 0.197±0.011 142(11.9) 1 055(88.1) 1 197(35.7) Q3组 0.296±0.148 71(7.0) 939(93.0) 1 010(30.1)
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表 3 社区绿地暴露与DM关联性分析
Table 3. Associations between neighborhood greenness exposure and DM.
社区绿地暴露 DM[OR(95% CI)值] 模型1 a 模型2 b NDVI-1 000 m Q1组 1.000 1.000 Q2组 0.995(0.773，1.280) 1.108(0.784，1.322) Q3组 0.488(0.354，0.672) 0.538(0.388，0.745) SAVI-1 000 m Q1组 1.000 1.000 Q2组 0.938(0.732，1.201) 0.910(0.701，1.182) Q3组 0.527(0.391，0.709) 0.605(0.440，0.833) 注：a未调整; b调整变量为性别，年龄，文化程度，婚姻状况，月收入，吸烟，DM家族史。
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表 4 社区绿地植被和DM的中介效应(%)
Table 4. Mediating effect of neighborhood greenness exposure and DM (%)
社区绿地暴露 总效应(95% CI)值 直接效应(95% CI)值 间接效应(95% CI)值 中介比例(95% CI)值 NDVI-1 000 m -15.86(-23.86~-8.00) -14.81(-22.71~-0.07) -1.05(-1.93~0.00) 6.42(1.83~16.00) SAVI-1 000 m -16.21(-24.57~-7.00) -15.00(-23.35~-0.06) -1.22(-2.19~0.00) 7.43(2.36~19.00) 注: 调整变量为性别，年龄，文化程度，婚姻状况，月收入，吸烟，DM家族史。
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