Research On Cardiovascular Risk Factors Of In Situ Urbanized Residents

Background:Since the 1990s,cardiovascular disease has been the main cause of disease burden in China.The incidence,morbidity and mortality of cardiovascular disease are still on the rise,and the phenomenon of younger age,higher prevalence in rural areas than urban areas and clustering of risk factors appeared.In the past 30 years,rapid urbanization in China has played a macro promoting role in the changes of living environment,psychology and behaviors of residents,which may lead to the change of cardiovascular risk.At present,urbanization in China has emerged from two processes:migration from rural to urban areas and in situ urbanization of rural areas.Researches on relationship between urbanization and cardiovascular health mostly focused on the former or urban-rural differences,while research on the latter is relatively scarce,especially the longitudinal research and mechanism research.In the process of in situ urbanization,residents have experienced changes in living environment,lifestyles,employment,economic status and so on,and the impact of these changes on their cardiovascular health is worthy of attention.Objectives:Taking Chaoyang District of Beijing as an example,based on the theory of social determinants of health and taking cardiovascular risk factors as the entry point,this study explored the impact of in situ urbanization on cardiovascular health of residents and its mechanism,providing a scientific basis for national and local governments to improve cardiovascular disease prevention and control strategies.Materials and Methods:The thesis follows these steps:(1)Research on characteristics of in situ urbanized residents and the trends of major risk factors for CVD.(2)Comparative study on major risk factors for CVD between in situ urbanized residents,urban residents,rural residents and rural to urban migrants in different periods.(3)Research on the impact of in situ urbanization on changes of CVD risk factors,(4)Research on the influencing factors for cardiovascular health of in situ urbanized residents.(5)Research on the mechanism for cardiovascular health of in situ urbanized residents.Data were obtained from population aged 35-64 of three studies:"Application of cardiovascular disease monitoring,prevention,warning and diagnosis techniques(Chaoyang monitoring stations in Beijing,data for 2010,2017and 2019)","Monitoring of adult chronic diseases and risk factors in Chaoyang district of Beijing 2011" and "Cohort study on chronic diseases of natural population in living communities in Beijing-Tianjin-Hebei Region(Chaoyang monitoring stations in Beijing,data for 2017)".The research included the following methods:(1)By using descriptive epidemiological method,the study summarized the main indicators reflecting the characteristics of in situ urbanized residents from the aspects of environment,behavior,psychology,sociology and health outcomes and described the main characteristics of in situ urbanized residents.(2)Based on the baseline data in 2010 and the follow-up data in 2017 and 2019,we used the generalized estimation equation to analyze the changes and trends of indicators related to CVD major risk factors in the initial stage,7 years and 9 years after in situ urbanization.(3)Using multiple linear regression model,log-binomial model to compare differences in the physiological and biochemical indexes,prevalence and aggregation of CVD major risk factors and atherosclerotic cardiovascular disease risk between in situ urbanized residents,urban residents,rural residents and rural to urban migrants in the initial stage and 7 years after in situ urbanization.(4)In order to analyze the impact of in situ urbanization and different ways of urbanization on changes of CVD major risk factors,the study compared the changes of indicators related to CVD risk factors between in situ urbanized residents and rural residents or between in situ urbanized residents and rural to urban migrants from 2010 to 2017 by using the methods of propensity score matching and difference in differences.(5)The study analyzed the direct and indirect correlation between the characteristic for in situ urbanization and the changes of indicators related to CVD major risk factors among in situ urbanized residents from four dimensions of subjective psychology,living conditions,working environment,and social capital.(6)The influence of social determinants on cardiovascular health of in situ urbanized residents were analyzed by structural equation model.The analysis includes the path,intensity and gender differences.Results:(1)After in situ urbanization,the housing conditions,economic conditions and subjective psychological state of residents have improved significantly,and they paid more attention to healthy lifestyles.However,in situ urbanized residents had a low-education and a high unemployed or retirement rate.Most of employed residents engaged in service industry(Cleaner,Property manager,Landscaper,Taxi driver)and business(Salesmen).Their social contacts were usually engaged in agricultural labor or the above service industries.(2)From 2010 to 2019,the level of FPG,BMI,DBP and HDL-C of in situ urbanized residents fluctuated obviously.FPG and BMI decreased from 2010 to 2017 and increased from 2017 to 2019,while DBP and HDL-C rose from 2010 to 2017 and dropped from 2017 to 2019.The prevalence of hypertension increased from 2010 to 2017,while current smoking rate decreased.TC,PBF,VFI and the rates of dyslipidemia,overweight or obesity and drinking increased from 2017 to 2019.From 2010 to 2019,CBP and the prevalence of diabetes rose steadily,while the rate of physical inactivity dropped.(3)In the early stage of urbanization,FPG and HDL-C of in situ urbanized residents were higher than those of other residents,and the prevalence of dyslipidemia was lower than that of other groups.After 7 years,DBP,TG,the rates of hypertension and diabetes were higher in this group than those of other population.Drinking rate and physical inactivity rate of in situ urbanized residents were lower than that in urban residents,rural residents and rural to urban migrants both at the beginning and seven years later of urbanization.Overall risk factors of in situ urbanized residents were highly concentrated,and the risk of ASCVD for young adults aged 35-44 had increased significantly.(4)In situ urbanization and migration urbanization both had positive and negative effects on residents' cardiovascular health,but there were significant differences in the direction and indicators of the effects.In situ urbanization had a broader impact on health indicators,and made most of the indicators change in a beneficial direction.The positive effects of 7 years in situ urbanization:FPG decreased by 0.357mmol/L,TC decreased by 0.273mmol/L,LDL-C decreased by 0.124mmol/L,BMI decreased by 0.553 kg/m2,the risk of smoking decreased by 56.3%,and the risk of physical inactivity decreased by 61.3%.The negative effects of 7 years in situ urbanization:DBP increased by 3.750 mm Hg,HDL-C decreased by 0.143 mmol/L.The positive effect of 7 years migration urbanization:SBP reduced 2.131mm Hg.The negative effects of 7 years migration urbanization:FPG,TC and TG increased by 0.349 mmol/L,0.201 mmol/L and 0.168 mmol/L,and the risk of drinking increased by 1.646 times.(5)Residential satisfaction,self-assessment satisfaction on life,sanitary facilities in the residence,distance between the residence and the main road,nature of the work unit,management situation,degree of work autonomy and social network heterogeneity of in situ urbanized residents were directly related to physiological and biochemical indexes of cardiovascular risk factors.There was an indirect correlation between the number of health promotion facilities around the residence and house property,the use of private cars,social support,social trust and physiological and biochemical indexes of cardiovascular risk factors.(6)Socioeconomic status had a direct impact on cardiovascular health,but also had an indirect impact on cardiovascular health through health-related behaviors,living environment and subjective well-being,and its total effect was the largest.The total effect of health-related behavior was second only to socioeconomic status and it also had direct and indirect effects on cardiovascular health.Living environment had an indirect impact on cardiovascular health through health-related behaviors and subjective well-being.Social capital had an indirect impact on cardiovascular health through subjective well-being,which appeared in most pathway and had a direct impact on cardiovascular health.In the path which socioeconomic status influenced cardiovascular health through health-related behaviors,there were significant differences in path coefficient in different gender group.Conclusions:In situ urbanization has improved living conditions,economic conditions and life satisfaction of residents,and some unhealthy behaviors of residents have also decreased.However,the rising trends of BP,FPG,lipids,overweight and obesity are still severe.Compared with other groups,level of education and job popularity of in situ urbanized residents are relatively lower,the average of cardiovascular risk factors is generally high.In situ urbanized residents has higher risk factors aggregation and overall risk.In situ urbanization not only can inhibit the rise of blood glucose,blood lipids,behavioral risk factors,overweight and obesity,but also can lead to the rise of blood pressure.In situ urbanization affects cardiovascular health in multiple ways and dimensions.The largest and most extensive impact comes from socioeconomic status.Changes in subjective psychological,behaviors,living environment and social capital have direct or indirect impact on cardiovascular health.Health-related behaviors and subjective well-being are important mediators for other factors to affect cardiovascular health.In order to reduce the CVD risk of in situ urbanized residents,the government needs to formulate cross-sectoral policies,start with supportive environmental construction and the health literacy promoting,and innovate comprehensive intervention mode and employment placement mode are also needed.