Investigating the relationship between active commuting and cardiovascular disease in the UK: Longitudinal and spatial analysis of four large datasets

众所周知，保持活跃可以降低我们患心血管疾病（CVD）、肥胖、高血压和其他健康问题的风险。然而，在过去的几十年里，英国人的生活方式变得越来越久坐，三分之二的人锻炼不足。在全球范围内，缺乏身体活动已成为过早死亡的第四大风险因素。专家们建议，积极的通勤（步行或骑自行车上班）是在日常生活中增加锻炼的一种实用方法。然而，还需要更多的研究。积极通勤影响心血管健康的确切方式尚不清楚，许多重要问题仍未得到解答。我希望在伦敦卫生和热带医学学院开始一个为期三年的医学研究理事会资助的项目，以了解积极的通勤是否对我们的健康有益。这项研究不仅关注步行和骑自行车旅行，还关注公共交通。乘火车、地铁或公共汽车通勤通常需要步行到车站，当服务忙碌时站着也需要一些体力消耗。将把这些主动和公共交通工具的使用者与乘坐私人交通工具（例如汽车、出租车或摩托车）通勤的人进行比较，后者通常久坐不动。该项目的核心目标是调查活跃的通勤者是否比非活跃的通勤者有更好的心血管健康。这包括心血管疾病的生物学前因（如肥胖和高血压）以及更具体的结果，如心脏病诊断和心血管疾病相关死亡。将考虑残疾、工作类型和地理位置等因素，以确保观察到的任何健康差异不能被这些其他因素所解释。此外，所使用的统计技术和数据源将使研究人员能够找出积极通勤是否真的会导致积极和非积极通勤者之间的健康差异。这种类型的研究是由英国丰富的纵向数据资源，其中三个将在本项目中使用：国家统计局纵向研究，英国家庭纵向研究，英国生物银行（中年人）。这些是大型研究，随着时间的推移跟踪成千上万的人，邀请同样的人在他们一生中的许多场合提供信息。此外，还将使用对青年人及其家庭进行的一项规模较小、重点更突出的纵向研究的数据。ORiEL（东伦敦奥运复兴）研究跟踪了大约3000名青少年，邀请他们提供调查数据，并在青春期三次测量他们的身高和体重。所有的青少年都在东伦敦生活和学习，他们通勤上学的城市环境的特点已经被测量和分类。利用ORiEL数据，该研究项目将调查所经过地区的属性是否影响年轻人步行上学，骑自行车，乘坐公共汽车或搭电梯。总之，该项目将回答一些关于积极通勤对健康影响的关键问题。它将显示积极的通勤对年轻人或中年人是否重要，以便公共卫生信息可以针对最关键的年龄组。它将显示环境因素，如人行道，犯罪和专用自行车路线，是否实际上增加了积极的旅行方式的使用。它将通过描述过去40年来积极通勤的趋势提供一个长期的视角，并显示长期积极旅行是否可以降低CVD死亡风险。它还将显示CVD“因果路径”上的哪些特定点最受积极通勤的影响：体重？健身？血压？还是心脏病本身？

It is well known that keeping active reduces our risk of cardiovascular disease (CVD), obesity, high blood pressure and other health problems. However over the past few decades British lifestyles have become increasingly sedentary, with two thirds of us taking insufficient exercise. Globally, physical inactivity has become the fourth leading risk factor for premature death. Active commuting (walking or cycling to work) has been recommended by experts as a practical way of building more exercise into the daily routine. However, more research is needed. The precise ways in which active commuting affects cardiovascular health are not understood, and many important questions remain unanswered. I hope to embark on a three-year Medical Research Council funded programme at the London School of Hygiene and Tropical Medicine, to find out whether active commuting is good for our health. The research will focus not just on walking and cycling trips, but on public transport too. Commuting by train, tube or bus usually involves a walk to the station, and standing when the service is busy also requires some physical exertion. Users of these active and public transport modes will be compared with people who commute by private transport (e.g. car, taxi or motorbike), which is usually more sedentary. The core objective of the project will be to investigate whether active commuters have better cardiovascular health than non-active commuters. This includes the biological antecedents of cardiovascular disease (such as obesity and high blood pressure) as well as more concrete outcomes such as heart disease diagnoses and CVD-related deaths. Factors such as disability, job type, and geographical location will be taken into account to ensure that any health differences observed cannot be explained away by these other elements. Furthermore, the statistical techniques and data sources used will allow the researcher to find out whether active commuting actually causes differences in health between active and non-active commuters. This type of research is made possible by the UK's rich longitudinal data resources, three of which will be used in this project: the Office for National Statistics Longitudinal Study, the UK Household Longitudinal Study, and UK Biobank (middle-aged individuals only). These are large studies which follow tens or hundreds of thousands of individuals over time, inviting the same people to provide information on a number of occasions through their lives. In addition, data from a smaller, more focussed longitudinal study of young people and their families will also be used. The ORiEL (Olympic Regeneration in East London) study follows around 3000 teenagers, inviting them to provide survey data and have their height and weight measured on three occasions during their adolescence. All of the teenagers live and study in East London and characteristics of the urban environment through which they commute to school have been measured and classified. Using the ORiEL data, the research project will investigate whether properties of the areas travelled through affect whether the young people walk to school, cycle, take the bus or get a lift. In summary, this project will answer a number of key questions about the health effects of active commuting. It will show whether active commuting is important for young people or middle-aged people, so that public health messages can be targeted at the most crucial age-group. It will show whether environmental factors such as pavements, crime and dedicated cycle routes actually increase the use of active travel modes. It will provide a long-range perspective by describing trends in active commuting over the past 4 decades and show whether long-term active travel can reduce CVD mortality risk. It will also show which particular points on the CVD 'causal pathway' are most influenced by active commuting: Weight? Fitness? Blood pressure? Or heart disease itself?