Socioeconomic inequalities in urban and transport planning related exposures and mortality: A health impact assessment study for Bradford, UK
Socioeconomic inequalities in urban and transport planning related exposures and mortality: A health impact assessment study for Bradford, UK
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DOI：
10.1016/j.envint.2018.10.017
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发表时间：
2018-12-01
影响因子：
11.8
通讯作者：
Nieuwenhuijsen, Mark
中科院分区：
文献类型：
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作者：
Mueller, Natalie;Rojas-Rueda, David;Nieuwenhuijsen, Mark
背景：城市具有独特的地理、环境和社会文化特征，影响其公民的健康状况。识别和修改这些特征可能有助于促进更健康的城市。目的：我们对英国布拉德福德（Bradford）成年居民（n = 393,091）的过早死亡影响进行了评估，评估了违反体育活动（PA）、空气污染、噪音和获得绿地的国际暴露指南的影响。方法：我们采用城市和交通规划健康影响评估（UTOPHIA）方法，估计不符合建议暴露水平的死亡率、预期寿命（LE）和经济影响。我们还调查了人口中死亡率负担的分布，重点关注由剥夺地位和种族定义的社会经济地位（SEP）。结果：我们估计，布拉德福德每年近10%的过早死亡（即375例死亡，95% CI: 276-474）可归因于未遵守推荐的暴露水平。据估计，不合规还导致超过300天的LE损失（95% CI: 238-432），这意味着每人的经济损失超过50,000 （95% CI: 38,518-69,991）。90%的过早死亡影响是由于PA性能不足造成的。空气和噪音污染以及缺乏绿色空间的影响较小（即48人死亡）。低SEP社区的居民不良暴露和过早死亡的风险最高。通过将空气和噪音污染水平降低到远远低于准则的水平，可以避免更多的死亡人数（即分别为253人和145人）。讨论：目前与城市和交通规划有关的暴露造成了相当大的健康负担，这种负担在布拉德福德人口中分布不均。改善城市和交通规划实践，包括减少机动交通和推广主动交通，以及绿化地区，特别是在低SEP地区，是提高PA绩效和减少有害环境暴露的有希望的策略。
Background: Cities have unique geographic, environmental and sociocultural characteristics that influence the health status of their citizens. Identification and modification of these characteristics may help to promote healthier cities.Objective: We estimated premature mortality impacts of breaching international exposure guidelines for physical activity (PA), air pollution, noise and access to green space for Bradford (UK) adult residents (n = 393,091).Methods: We applied the Urban and TranspOrt Planning Health Impact Assessment (UTOPHIA) methodology and estimated mortality, life expectancy (LE) and economic impacts of non-compliance with recommended exposure levels. We also investigated the distribution of the mortality burden among the population, focusing on socioeconomic position (SEP) as defined by deprivation status and ethnicity.Results: We estimated that annually almost 10% of premature mortality (i.e. 375 deaths, 95% CI: 276-474) in Bradford is attributable to non-compliance with recommended exposure levels. Non-compliance was also estimated to result in over 300 days of LE lost (95% CI: 238-432), which translated in economic losses of over 50,000 per person (95% CI: 38,518-69,991). 90% of the premature mortality impact resulted from insufficient PA performance. Air and noise pollution and the lack of green space had smaller impacts (i.e. 48 deaths). Residents of lower SEP neighborhoods had the highest risks for adverse exposure and premature death. A larger number of deaths (i.e. 253 and 145, respectively) could be prevented by reducing air and noise pollution levels well below the guidelines.Discussion: Current urban and transport planning related exposures result in a considerable health burden that is unequally distributed among the Bradford population. Improvements in urban and transport planning practices including the reduction of motor traffic and the promotion of active transport together with greening of the district, particularly in areas of lower SEP, are promising strategies to increase PA performance and reduce harmful environmental exposures.