Assessing the built environment through photographs and its association with obesity in 21 countries: the PURE Study

Corsi D.J. Marschner S. Lear S. Hystad P. Rosengren A. Ismail R. Yeates K. Swaminathan S. Puoane T. Wang C. Li Y. Rangarajan S. Kruger I.M. Chifamba J. Vidhu Kumar K. Mohan I. Davletov K. Artamonov G. Palileo-Villanueva L.M. Mat-Nasir N. Zatonska K. Oguz A. Bahonar A. Alhabib K.F. Yusufali A. Lopez-Jaramillo P. Lanas F. Galatte A. Avezum Á. Mckee M. Yusuf S. Chow C.K.
November 2024 Elsevier Ltd

The Lancet Global Health
2024 #12 Issue 11 e1794 - e1806 pp.

Background: The built environment can influence human health, but the available evidence is modest and almost entirely from urban communities in high-income countries. Here we aimed to analyse built environment characteristics and their associations with obesity in urban and rural communities in 21 countries at different development levels participating in the Prospective Urban and Rural Epidemiology (PURE) Study. Methods: Photographs were acquired with a standardised approach. We used the previously validated Environmental Profile of a Communitys Health photo instrument to evaluate photos for safety, walkability, neighbourhood beautification, and community disorder. An integrated built environment score (ie, a minimum of 0 and a maximum of 20) was used to summarise this evaluation across built environment domains. Associations between built environment characteristics, separately and combined in the integrated built environment score, and obesity (ie, a BMI >30kg/m²) were assessed using multilevel regression models, adjusting for individual, household, and community confounding factors. Attenuation in the associations due to walking was examined. Findings: Analyses include 143 338 participants from 530 communities. The mean integrated built environment score was higher in high-income countries (13·3, SD 2·8) compared with other regions (10·1, 2·5) and urban communities (11·2, 3·0). More than 60% of high-income country communities had pedestrian safety features (eg, crosswalks, sidewalks, and traffic signals). Urban communities outside high-income countries had higher rates of sidewalks (176 [84%] of 209) than rural communities (59 [28%] of 209). 15 (5%) of 290 urban communities had bike lanes. Litter and graffiti were present in 372 (70%) of 530 communities, and poorly maintained buildings were present in 103 (19%) of 530. The integrated built environment score was significantly associated with reduced obesity overall (relative risk [RR] 0·58, 95% CI 0·35–0·93; p=0·025) for high compared with low scores and for increasing trend (0·85, 0·78–0·91; p<0·0001). The trends were statistically significant in urban (0·85, 0·77–0·93; p=0·0007) and rural (0·87, 0·78–0·97; p=0·015) communities. Some built environment features were associated with a lower prevalence of obesity: community beautification RR 0·75 (95% CI 0·61–0·92; p=0·0066); bike lanes RR 0·58 (0·45–0·73; p<0·0001); pedestrian safety RR 0·75 (0·62–0·90; p=0·0018); and traffic signals RR 0·68 (0·52–0·89; p=0·0055). Community disorder was associated with a higher prevalence of obesity (RR 1·48, 95% CI 1·17–1·86; p=0·0010). Interpretation: Community built environment features recorded in photographs, including bike lanes, pedestrian safety measures, beautification, traffic density, and disorder, were related to obesity after adjusting for confounders, and stronger associations were found in urban than rural communities. The method presents a novel way of assessing the built environments potential effect on health. Funding: Population Health Research Institute, Hamilton Health Sciences Research Institute, Heart and Stroke Foundation of Ontario, Canadian Institutes of Health Researchs Strategy for Patient Oriented Research, Ontario Support Unit, Ontario Ministry of Health and Long-Term Care, AstraZeneca, Sanofi–Aventis, Boehringer Ingelheim, Servier, and GlaxoSmithKline.

Text of the article Перейти на текст статьи

School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
Westmead Applied Research Centre, Faculty of Medicine & Health, The University of Sydney, Westmead, NSW, Australia
Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
Department of Community Health, Faculty of Medicine, University Kebangsaan Malaysia, Bangi, Malaysia
Department of Medicine, Queens University, Belfast, United Kingdom
St Johns Research Institute, Bangalore, India
School of Public Health, University of the Western Cape, Cape Town, South Africa
Medical Research and Biometrics Center, National Center for Cardiovascular Disease, Fuwai Hospital, Beijing, China
Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
Department of Biomedical Sciences, University of Zimbabwe, Harare, Zimbabwe
Health Action by People, Kerala, India
Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, India
Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
Federal State Budgetary Institution Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation
UP College of Medicine, University of the Philippines Manila, Manila, Philippines
Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Selangor, Malaysia
Department of Population Health, Wroclaw Medical University, Wroclaw, Poland
Department of Internal Medicine, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud Medical City, King Saud University, Riyadh, Saudi Arabia
Tamani Foundation, Zanzibar, Tanzania
Masira Research Institute, Universidad de Santander, Bucaramanga, Colombia
Universidad de La Frontera, Temuco, Chile
ECLA, Santa Fe, Rosario, Argentina
International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
London School of Hygiene & Tropical Medicine, London, United Kingdom

School of Epidemiology and Public Health
Westmead Applied Research Centre
Faculty of Health Sciences
School of Biological and Population Health Sciences
Sahlgrenska Academy
Department of Community Health
Department of Medicine
St Johns Research Institute
School of Public Health
Medical Research and Biometrics Center
Population Health Research Institute
Africa Unit for Transdisciplinary Health Research
Department of Biomedical Sciences
Health Action by People
Mahatma Gandhi University of Medical Sciences and Technology
Asfendiyarov Kazakh National Medical University
Federal State Budgetary Institution Research Institute for Complex Issues of Cardiovascular Diseases
UP College of Medicine
Department of Primary Care Medicine
Department of Population Health
Department of Internal Medicine
Isfahan Cardiovascular Research Center
Department of Cardiac Sciences
Tamani Foundation
Masira Research Institute
Universidad de La Frontera
ECLA
International Research Center
London School of Hygiene & Tropical Medicine

10 лет помогаем публиковать статьи Международный издатель

Книга Публикация научной статьи Волощук 2026 Book Publication of a scientific article 2026