基于倾向值匹配法的城市建成环境对居民生理健康的影响
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摘要
伴随着城市化和机动化进程,肥胖及其引致的慢性疾病已成为中国严峻的社会问题。本文利用2010年中国社会综合调查、空间兴趣点POI、道路网等数据,探究城市建成环境对居民生理健康状况的影响,并通过倾向值匹配法控制自选择机制的干扰。研究发现:(1)高密度的土地利用对居民总体的身体健康状况具有负向影响,而功能混合、支路网通达的城市肌理、以及充足的健康设施在降低身体质量指数BMI、抑制超重和减少慢性病方面发挥着积极作用。(2)各类建成环境特征对中高社会阶层的影响集中在主观的健康感知,对中低阶层人群的影响则主要作用于客观的健康指标。(3)小尺度范围内的建成环境与中低阶层群体的身体健康水平存在更为密切的关联,但这一规律在中高社会阶层并不明显。本研究证明了主动式空间干预手段在促进居民生理健康过程中的有效性,进而就建成环境的优化策略提出了初步建议。
With the process of urbanization and motorization, obesity and chronic diseases have become a serious social problem, but the empirical study on the impact of urban built environment on public physical health is still lacking in Chinese context. In this paper, we use the data from China's general social survey in 2010 and select 6740 samples in 278 urban communities throughout 31 provincial areas. Other geographical data are also introduced into the analysis, such as point of interests and road network surrounding each community. In order to control the interference of self-selection mechanism, this research uses a quasi-experimental method called propensity score matching. According to this empirical analysis, firstly, the study indicates that high-density land use has a negative impact on the overall physical health of the residents, which is contrary to comparatively low density developed cities in Western countries.Nevertheless, similar to international literatures, all of the mixed urban function, urban texture with an accessible branch network, and adequate health facilities play a positive role in reducing BMI, inhibiting overweight and lowering chronic diseases. Secondly, these built environment elements have various impacts on different social classes. The upper class is mainly influenced in the subjective physical health perception while the lower class is more affected in the objective physical health status. Thirdly, there is a closer relationship between the ambient built environment characteristics of small spatial scale and the health status of middle-and low-stratum groups, but this rule is not obvious among middle and high social classes, which reflects that the surrounding environmental quality of public space has a more direct and important impact on the physical health of vulnerable groups. In conclusion, this study proves the effectiveness of active spatial intervention in the process of improving public physical health as well as alleviating health inequality problem, and then puts forward some suggestions on optimization strategy of urban built environment in China.
With the process of urbanization and motorization, obesity and chronic diseases have become a serious social problem, but the empirical study on the impact of urban built environment on public physical health is still lacking in Chinese context. In this paper, we use the data from China's general social survey in 2010 and select 6740 samples in 278 urban communities throughout 31 provincial areas. Other geographical data are also introduced into the analysis, such as point of interests and road network surrounding each community. In order to control the interference of self-selection mechanism, this research uses a quasi-experimental method called propensity score matching. According to this empirical analysis, firstly, the study indicates that high-density land use has a negative impact on the overall physical health of the residents, which is contrary to comparatively low density developed cities in Western countries.Nevertheless, similar to international literatures, all of the mixed urban function, urban texture with an accessible branch network, and adequate health facilities play a positive role in reducing BMI, inhibiting overweight and lowering chronic diseases. Secondly, these built environment elements have various impacts on different social classes. The upper class is mainly influenced in the subjective physical health perception while the lower class is more affected in the objective physical health status. Thirdly, there is a closer relationship between the ambient built environment characteristics of small spatial scale and the health status of middle-and low-stratum groups, but this rule is not obvious among middle and high social classes, which reflects that the surrounding environmental quality of public space has a more direct and important impact on the physical health of vulnerable groups. In conclusion, this study proves the effectiveness of active spatial intervention in the process of improving public physical health as well as alleviating health inequality problem, and then puts forward some suggestions on optimization strategy of urban built environment in China.
引文
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[16]Pouliou T,Elliott S J.Individual and socio-environmental determinants of overweight and obesity in Urban Canada.Health&Place,2010,16(2):389-398.
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[19]Kelly-Schwartz A C,Stockard J,Doyle S,et al.Is sprawl unhealthy?A multilevel analysis of the relationship of metropolitan sprawl to the health of individuals.Journal of Planning Education and Research,2004,24(24):184-196.
[20]Joshu C E,Beehmer T K,Brownson R C,et al.Personal,neighbourhood and urban factors associated with obesity in the United States.Journal of Epidemiology and Community Health,2008,62(3):202-208.
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[22]Ewing R,Meakins G,Hamidi S,et al.Relationship between urban sprawl and physical activity,obesity,and morbidity:Update and refinement.Health&Place,2014,26(2):118-126.
[23]Forsyth A,Oakes J M,Lee B,et al.The built environment,walking,and physical activity:Is the environment more important to some people than others?Transportation Research Part D,2009,14(1):42-49.
[24]Doyle S,Kelly-Schwartz A,Schlossberg M,et al.Active community environments and health:The relationship of walkable and safe communities to individual health.Journal of the American Planning Association,2006,72(1):19-31.
[25]Samimi A,Mohammadian A,Madanizadeh S.Effects of transportation and built environment on general health and obesity.Transportation Research Part D,2009,14(1):67-71.
[26]Mac Donald J M,Stokes R J,Cohen D A.The effect of light rail transit on body mass index and physical activity.American Journal of Preventive Medicine,2010,39(2):105-112.
[27]Xu Y,Wen M,Wang F.Multilevel built environment features and individual odds of overweight and obesity in Utah.Applied Geography,2015,60(S1):197-203.
[28]Morland K,Roux A V D,Wing S.Supermarkets,other food stores,and obesity:The atherosclerosis risk in communities study.American Journal of Preventive Medicine,2006,30(4):333-339.
[29]Fraser L K,Clarke G P,Cade J E,et al.Fast food and obesity:A spatial analysis in a large united kingdom population of children aged 13-15.American Journal of Preventive Medicine,2012,42(5):e77-e85.
[30]Chi S H,Grigsby-Toussaint D S,Bradford N,et al.Can geographically weighted regression improve our contextual understanding of obesity in the US?Findings from the USDA Food Atals.Applied Geography,2013,44(4):134-142.
[31]James P,Berrigan D,Hart J E,et al.Effects of buffer size and shape on associations between the built environment and energy balance.Health&Place,2014,27(3):162-170.
[32]Frank L D,Engelke P O.The built environment and human activity patterns:Exploring the impacts of urban form on public health.Journal of Planning Literature,2001,16(2):202-218.
[33]Guo Shenyang,Fraser M W.Propensity Score Analysis:Statistical Methods and Applications.Chongqing:Chongqing University Press,2012.[郭申阳,弗雷泽M W.倾向值分析:统计方法与应用.重庆:重庆大学出版社,2012.]
[34]Xu Y,Wang L.GIS-based analysis of obesity and the built environment in the US.Cartography and Geographic Information Science,2015,42(1):9-21.
[35]Frank L D,Kerr J,Sallis J F,et al.A hierarchy of sociodemographic and environmental correlates of walking and obesity.Preventive Medicine,2008,47(2):172-178.
[36]Lin Xiongbin,Yang Jiawen.Built environment and public health review and planning in North American metropolitan areas.Planners,2015,31(6):12-19.[林雄斌,杨家文.北美都市区建成环境与公共健康关系的研究述评及其启示.规划师,2015,31(6):12-19.]
[37]Wang Lan,Liao Shuwen,Zhao Xiaojing.Exploration of approaches and factors of healthy city planning.Urban Planning International,2016,31(4):4-9.[王兰,廖舒文,赵晓菁.健康城市规划路径与要素辨析.国际城市规划,2016,31(4):4-9.]
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(1)有关CGSS的详细信息可参见http://www.chinagss.org/,本文内容由作者自行负责。为保护调查对象的隐私,分析时数据库已对样本做了匿名处理,其地理定位仅至居委会尺度,未涉及具体住所地址。
(2)参考城市建设用地分类标准(GB50137-2011),依据POI的小类或名称,将其归入行政办公(A1)、文化设施(A2)、教育科研(A3)、体育(A4)、医疗卫生(A5)、社会福利(A6)、文物古迹或宗教(A7、A9)、外事(A8)、零售商业(B11)、批发(B12)、餐饮(B13)、旅馆(B14)、金融保险(B21)、艺术传媒(B22)、其他商务设施(B29)、娱乐康体(B3)、加油加气(B41)、其他公用设施(B49)、其它服务设施(B9)、公园(G1)、广场(G3)、一类住宅(R11)、二三类住宅(R21、R31)、服务设施(R12、R22、R32)、城市道路(S1)、轨道交通(S2)、综合交通枢纽(S3)、公共交通设施(S41)、社会停车场(S42)、工业(M)、物流仓储(W)等31类用地性质。
(3)CGSS 2010仅针对出生于1月、4月、6月、8月的被调查者搜集了罹患慢性疾病的信息,样本量为2174人。除该变量外,其余所有变量的样本数为6740人。
(4)参考Rosenbaum等的建议[47],半径大小采用样本估计的倾向值标准差的1/4。(5)CGSS 2010在对阶层的自我评价时,将社会群体分为10个等级,以10分代表社会最顶层阶层,以1分代表最底层阶层。在正式分析中,本文根据被调查者的主观判断,将填写5分及以下的样本归入中低社会阶层、6分及以上的样本归入中高社会阶层,两者比例为4.4∶1。此外,本研究还基于“家庭经济状况在当地属于哪一档”(以李克特5点量表测量),将收入高于平均水平者作为中高社会阶层、处于平均水平或低于平均水平者作为中低社会阶层,就建成环境对不同阶层生理健康状况的影响差异进行稳健性检验,其结论与正式分析相似。受篇幅所限,读者可向作者索取分析结果。
[2]Popkin B M.Will China's nutrition transition overwhelm its health care system and slow economic growth?Health Affairs,2008,27(4):1064-1076.
[3]Jie E.The economic impact of chronic diseases in Chinese residents.World Economic Papers,2011(3):74-86.[解垩.中国居民慢性病的经济影响.世界经济文汇,2011(3):74-86.]
[4]Giles-Corti B,Vernez-Moudon A,Reis R,et al.City planning and population health:a global challenge.The Lancet,2016,388(10062):2912-2924.
[5]Lee I,Shiroma E J,Lobelo F,et al.Effect of physical inactivity on major non-communicable diseases worldwide:An analysis of burden of disease and life expectancy.The Lancet,2012,380(9838):219-229.
[6]Thorp A A,Owen N,Neuhaus M,et al.Sedentary behaviors and subsequent health outcomes in adults:A systematic review of longitudinal studies,1996-2011.American Journal of Preventive Medicine,2011,41(2):207-215.
[7]Lock K,Pomerleau J,Causer L,et al.The global burden of disease attributable to low consumption of fruit and vegetables:Implications for the global strategy on diet.Bulletin of the World Health Organization,2005,83(2):100-108.
[8]Loon J V,Frank L.Urban form relationships with youth physical activity:Implications for research and practice.Journal of Planning Literature,2011,26(3):280-308.
[9]Gibson J M,Rodriguez D,Dennerlein T,et al.Predicting urban design effects on physical activity and public health:A case study.Health&Place,2015,35(9):79-84.
[10]Feng J,Glass T A,Curriero F C,et al.The built environment and obesity:A systematic review of the epidemiologic evidence.Health&Place,2010,16(2):175-190.
[11]Kerr J,Rosenberg D,Frank L.The role of the built environment in healthy aging:Community design,physical activity,and health among older adults.Journal of Planning Literature,2012,27(1):43-60.
[12]Barton H,Grant M.A health map for the local human habitat.The Journal of the Royal Society for the Promotion of Health,2006,126(6):252-261.
[13]Barton H.Land use planning and health and well-being.Land Use Policy,2009,26(12):S115-S123.
[14]Cao X,Fan Y.Exploring the influence of density on travel behavior using propensity score matching.Environmental and Planning B:Planning and Design,2012,39(3):459-470.
[15]Frank L D,Sallis J F,Conway T L,et al.Many pathways from land use to health:Associations between neighborhood walkability and active transportation,body mass index,and air quality.Journal of the American Planning Association,2006,72(1):75-87.
[16]Pouliou T,Elliott S J.Individual and socio-environmental determinants of overweight and obesity in Urban Canada.Health&Place,2010,16(2):389-398.
[17]Frank L D,Andresen M A,Schmid T L.Obesity relationships with community design,physical activity,and time spent in cars.American Journal of Preventive Medicine,2004,27(2):87-96.
[18]Lopez-Zetina J,Lee H,Friis R.The link between obesity and the built environment:Evidence from an ecological analysis of obesity and vehicle miles of travel in California.Health&Place,2006,12(4):656-664.
[19]Kelly-Schwartz A C,Stockard J,Doyle S,et al.Is sprawl unhealthy?A multilevel analysis of the relationship of metropolitan sprawl to the health of individuals.Journal of Planning Education and Research,2004,24(24):184-196.
[20]Joshu C E,Beehmer T K,Brownson R C,et al.Personal,neighbourhood and urban factors associated with obesity in the United States.Journal of Epidemiology and Community Health,2008,62(3):202-208.
[21]Lathey V,Guhathakurta S,Aggarwal R M.The impact of subregional variations in urban sprawl on the prevalence of obesity and related morbidity.Journal of Planning Education and Research,2009,29(2):127-141.
[22]Ewing R,Meakins G,Hamidi S,et al.Relationship between urban sprawl and physical activity,obesity,and morbidity:Update and refinement.Health&Place,2014,26(2):118-126.
[23]Forsyth A,Oakes J M,Lee B,et al.The built environment,walking,and physical activity:Is the environment more important to some people than others?Transportation Research Part D,2009,14(1):42-49.
[24]Doyle S,Kelly-Schwartz A,Schlossberg M,et al.Active community environments and health:The relationship of walkable and safe communities to individual health.Journal of the American Planning Association,2006,72(1):19-31.
[25]Samimi A,Mohammadian A,Madanizadeh S.Effects of transportation and built environment on general health and obesity.Transportation Research Part D,2009,14(1):67-71.
[26]Mac Donald J M,Stokes R J,Cohen D A.The effect of light rail transit on body mass index and physical activity.American Journal of Preventive Medicine,2010,39(2):105-112.
[27]Xu Y,Wen M,Wang F.Multilevel built environment features and individual odds of overweight and obesity in Utah.Applied Geography,2015,60(S1):197-203.
[28]Morland K,Roux A V D,Wing S.Supermarkets,other food stores,and obesity:The atherosclerosis risk in communities study.American Journal of Preventive Medicine,2006,30(4):333-339.
[29]Fraser L K,Clarke G P,Cade J E,et al.Fast food and obesity:A spatial analysis in a large united kingdom population of children aged 13-15.American Journal of Preventive Medicine,2012,42(5):e77-e85.
[30]Chi S H,Grigsby-Toussaint D S,Bradford N,et al.Can geographically weighted regression improve our contextual understanding of obesity in the US?Findings from the USDA Food Atals.Applied Geography,2013,44(4):134-142.
[31]James P,Berrigan D,Hart J E,et al.Effects of buffer size and shape on associations between the built environment and energy balance.Health&Place,2014,27(3):162-170.
[32]Frank L D,Engelke P O.The built environment and human activity patterns:Exploring the impacts of urban form on public health.Journal of Planning Literature,2001,16(2):202-218.
[33]Guo Shenyang,Fraser M W.Propensity Score Analysis:Statistical Methods and Applications.Chongqing:Chongqing University Press,2012.[郭申阳,弗雷泽M W.倾向值分析:统计方法与应用.重庆:重庆大学出版社,2012.]
[34]Xu Y,Wang L.GIS-based analysis of obesity and the built environment in the US.Cartography and Geographic Information Science,2015,42(1):9-21.
[35]Frank L D,Kerr J,Sallis J F,et al.A hierarchy of sociodemographic and environmental correlates of walking and obesity.Preventive Medicine,2008,47(2):172-178.
[36]Lin Xiongbin,Yang Jiawen.Built environment and public health review and planning in North American metropolitan areas.Planners,2015,31(6):12-19.[林雄斌,杨家文.北美都市区建成环境与公共健康关系的研究述评及其启示.规划师,2015,31(6):12-19.]
[37]Wang Lan,Liao Shuwen,Zhao Xiaojing.Exploration of approaches and factors of healthy city planning.Urban Planning International,2016,31(4):4-9.[王兰,廖舒文,赵晓菁.健康城市规划路径与要素辨析.国际城市规划,2016,31(4):4-9.]
[38]Xu F,Li J,Liang Y,et al.Residential density and adolescent overweight in a rapidly urbanizing region of mainland China.Journal of Epidemiology and Community Health,2010,64(11):1017-1021.
[39]Alfonzo M,Guo Z,Lin L,et al.Walking,obesity and urban design in Chinese neighborhoods.Preventive Medicine,2014,69:S79-S85.
[40]Chen J,Chen S,Landry P F.Migration,environmental hazards,and health outcomes in China.Social Science&Medicine,2013,80:85-95.
[41]Ma J,Mitchell G,Dong G,et al.Inequality in Beijing:A spatial multilevel analysis of perceived environmental hazard and self-rated health.Annals of the American Association of Geographers,2017,107(1):109-129.
[42]Sun Bindong,Yan Hong,Zhang Tinglin.Impact of community built environment on residents'health:A case study on individual overweight.Acta Geographica Sinca,2016,71(10):1721-1730.[孙斌栋,阎宏,张婷麟.社区建成环境对健康的影响:基于居民个体超重的实证研究.地理学报,2016,71(10):1721-1730.]
[43]Cervero R,Kockelman K.Travel demand and the 3Ds:Density,diversity,and design.Transportation Research D,1997,2(3):199-219.
[44]Ewing R,Cervero R.Travel and the built environment.Transportation Research Record,2001,1780:87-114.
[45]An Taisheng.AMOS and Research Method.Chongqing:Chongqing University Press,2009:84-86.[安泰生.AMOS与研究方法.重庆:重庆大学出版社,2009:84-86.]
[46]Hu Anning.Propensity score matching and causal inference:A methodological review.Sociological Studies,2012(1):221-242.[胡安宁.倾向值匹配与因果推论:方法论述评.社会学研究,2012(1):221-242.]
[47]Rosenbaum P R,Rubin D B.Constructing a control group using multivariate matched sampling methods that incorporate the propensity score.The American Statistician,1985,39(1):33-38.
[48]Sheng Qiang.Distribution logic of local public space:A spatial configuration analysis on the local shops inside 222urban blocks in the Third Ring of Beijing.Urban Planning International,2012,27(6):61-68.[盛强.社区级活力中心分布的空间逻辑:以北京三环内222个街区内小商业集聚为例.国际城市规划,2012,27(6):61-68.]
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(1)有关CGSS的详细信息可参见http://www.chinagss.org/,本文内容由作者自行负责。为保护调查对象的隐私,分析时数据库已对样本做了匿名处理,其地理定位仅至居委会尺度,未涉及具体住所地址。
(2)参考城市建设用地分类标准(GB50137-2011),依据POI的小类或名称,将其归入行政办公(A1)、文化设施(A2)、教育科研(A3)、体育(A4)、医疗卫生(A5)、社会福利(A6)、文物古迹或宗教(A7、A9)、外事(A8)、零售商业(B11)、批发(B12)、餐饮(B13)、旅馆(B14)、金融保险(B21)、艺术传媒(B22)、其他商务设施(B29)、娱乐康体(B3)、加油加气(B41)、其他公用设施(B49)、其它服务设施(B9)、公园(G1)、广场(G3)、一类住宅(R11)、二三类住宅(R21、R31)、服务设施(R12、R22、R32)、城市道路(S1)、轨道交通(S2)、综合交通枢纽(S3)、公共交通设施(S41)、社会停车场(S42)、工业(M)、物流仓储(W)等31类用地性质。
(3)CGSS 2010仅针对出生于1月、4月、6月、8月的被调查者搜集了罹患慢性疾病的信息,样本量为2174人。除该变量外,其余所有变量的样本数为6740人。
(4)参考Rosenbaum等的建议[47],半径大小采用样本估计的倾向值标准差的1/4。(5)CGSS 2010在对阶层的自我评价时,将社会群体分为10个等级,以10分代表社会最顶层阶层,以1分代表最底层阶层。在正式分析中,本文根据被调查者的主观判断,将填写5分及以下的样本归入中低社会阶层、6分及以上的样本归入中高社会阶层,两者比例为4.4∶1。此外,本研究还基于“家庭经济状况在当地属于哪一档”(以李克特5点量表测量),将收入高于平均水平者作为中高社会阶层、处于平均水平或低于平均水平者作为中低社会阶层,就建成环境对不同阶层生理健康状况的影响差异进行稳健性检验,其结论与正式分析相似。受篇幅所限,读者可向作者索取分析结果。