The association of neighborhood walkability with health outcomes in older adults after acute myocardial infarction: The SILVER-AMI study.
The association of neighborhood walkability with health outcomes in older adults after acute myocardial infarction: The SILVER-AMI study.
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邻里可步行性与急性心肌梗死后老年人健康结局的关联：SILVER-AMI研究
DOI：
10.1016/j.pmedr.2021.101391
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发表时间：
2021-09
影响因子：
2.8
通讯作者：
Chaudhry SI
中科院分区：
文献类型：
--
作者：
Roy B;Hajduk AM;Tsang S;Geda M;Riley C;Krumholz HM;Chaudhry SI
体力活动和社会支持与急性心肌梗死（AMI）存活后的较好预后相关，而社区更强的宜步行性与体力活动及社会支持有关。我们利用SILVER-AMI研究（2014年11月至2017年6月）的数据进行分析。该研究是一项针对因急性心肌梗死住院、年龄≥75岁且生活在社区的成年人的纵向队列研究，旨在评估社区宜步行性与健康预后之间的关联，并确定体力活动和社会支持是否在二者存在关联的情况下起到中介作用。我们纳入了1345名参与者的数据，这些参与者没有卧床不起，出院后回家，且我们成功获取了他们家庭所在普查街区的宜步行性得分（来自Walk Score®）。我们的主要结局指标是出院后6个月的无住院生存时间（HFST）；次要结局指标包括出院6个月时使用SF-12量表评估的身心健康状况。体力活动和社会支持情况在基线时进行测量。协变量包括认知能力、功能状态、合并症、是否参与康复或物理治疗以及人口统计学特征。我们采用生存分析方法，在调整协变量前后，研究宜步行性与无住院生存时间之间的关联；我们还以身心健康作为结局指标，采用线性回归重复进行分析。在调整后的模型中，宜步行性与身体健康（β = 0.010；95%置信区间：-0.027，0.047）、心理健康（β = -0.08；95%置信区间：-0.175，-0.013）或无住院生存时间（β = 0.008；95%置信区间：-0.023，0.009）均无关联。在调整后的模型中，社会支持与心理健康相关。对于患有冠心病的老年人，社区宜步行性并不能预测其健康预后，这表明在老年人中，行动能力受限可能比社区宜步行性更为关键 。
Physical activity and social support are associated with better outcomes after surviving acute myocardial infarction (AMI), and greater walkability has been associated with activity and support. We used data from the SILVER-AMI study (November 2014–June 2017), a longitudinal cohort of community-living adults ≥ 75 years hospitalized for AMI to assess associations of neighborhood walkability with health outcomes, and to assess whether physical activity and social support mediate this relationship, if it exists. We included data from 1345 participants who were not bedbound, were discharged home, and for whom we successfully linked walkability scores (from Walk Score®) for their home census block. Our primary outcome was hospital-free survival time (HFST) at six months after discharge; secondary outcomes included physical and mental health at six months, assessed using SF-12. Physical activity and social support were measured at baseline. Covariates included cognition, functioning, comorbidities, participation in rehabilitation or physical therapy, and demographics. We employed survival analysis to examine associations between walkability and HFST, before and after adjustment for covariates; we repeated analyses using linear regression with physical and mental health as outcomes. In adjusted models, walkability was not associated with physical health (ß = 0.010; 95% CI: −0.027, 0.047), mental health (ß = −0.08; 95% CI: −0.175, −0.013), or HFST (ß = 0.008; 95% CI: −0.023, 0.009). Social support was associated with mental health in adjusted models. Neighborhood walkability was not predictive of outcomes among older adults with existing coronary disease, suggesting that among older adults, mobility limitations may supercede neighborhood walkability.
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