ObjectiveWe aimed to estimate the current use of secondary prevention drugs and identify its associated individual characteristics among those with established cardiovascular diseases (CVDs) in the communities of China.MethodsWe studied 2 613 035 participants aged 35–75 years from 8577 communities in 31 provinces in the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project, a government-funded public health programme conducted from 2014 to 2018. Participants self-reported their history of ischaemic heart disease (IHD) or ischaemic stroke (IS) and medication use in an interview. Multivariable mixed models with a logit link function and community-specific random intercepts were fitted to assess the associations of individual characteristics with the reported use of secondary prevention therapies.ResultsAmong 2 613 035 participants, 2.9% (74 830) reported a history of IHD and/or IS, among whom the reported use rate either antiplatelet drugs or statins was 34.2% (31.5% antiplatelet drugs, 11.0% statins and 8.3% both). Among the 1 530 408 population subgroups, which were defined by all possible permutations of 16 individual characteristics, reported use of secondary prevention drugs varied substantially (8.4%–60.6%). In the multivariable analysis, younger people, women, current smokers, current drinkers, people without hypertension or diabetes and those with established CVD for more than 2 years were less likely to report taking antiplatelet drugs or statins.ConclusionsThe current use of secondary prevention drugs in China is suboptimal and varies substantially across population subgroups. Our study identifies target populations for scalable, tailored interventions to improve secondary prevention of CVD.

背景心力衰竭,简称心衰,给我国带来了沉重的社会和经济负担.B型利钠肽作为心衰的重要生物标志物,被国内外指南一致作为Ⅰ类推荐.然而,我国B型利钠肽检测在心衰临床诊疗中的应用情况未见报道.目的研究分析2015年我国心衰住院诊疗中在医院水平应用B型利钠肽检测的可及性和检测率.方法 2015年“重大慢病国家注册登记研究—心力衰竭回顾性病历登记研究”(简称China PEACE心衰回顾性病历登记研究)采用分层两阶段随机抽样方法:第一阶段,将全国按经济区域划分为5层,采用简单随机抽样方法确定研究的协作医院;第二阶段,采用系统随机抽样方法,从每家协作医院抽取2015年出院诊断为心衰的住院患者病历.收集协作医院的基本信息,提取心衰患者住院病历信息,分析医院水平B型利钠肽检测的可及性和检测率,规定B型利钠肽检测率≥60％为B型利钠肽医院应用及格.结果 最终纳入188家医院共计15 163份心衰病历.2015年B型利钠肽检测的整体可及性为85.1％ (160/188),各经济地域医院的B型利钠肽检测的整体可及性分布比较,差异有统计学意义(x2=34.3,P＜0.01).多因素Logistic回归分析结果显示,有独立心内科[OR=6.40, 95％CI (1.78, 23.05)]、医院床位数＞300张[OR=4.45,95％CI(1.24,15.95)]是医院水平B型利钠肽检测可及性的影响因素(P＜0.05),同时B型利钠肽在西部农村地区的检测可及性低于东部城市地区[OR=0.37, 95％CI (0.14,0.96),P＜0.05].159家研究的可及医院中B型利钠肽的整体检测率为63.5％(40.0％,82.3％).各经济地域医院的B型利钠肽检测率比较,差异有统计学意义(H=13.19,P=0.01).多因素Logistic回归分析结果显示,有独立心内科[OR=4.91,95％CI(1.53,15.77)]是B型利钠肽医院应用及格的影响因素(P＜0.05).结论 2015年B型利钠肽检测在全国医院水平已基本普及,但就有检测能力的医院而言,在心衰住院患者临床诊疗的检测率有待提高.因此,需要继续推广诊疗指南在临床实践中的应用,特别重视对西部农村地区的资源投入.

China has substantially increased financial investment and introduced favourable policies for strengthening its primary health care system with core responsibilities in preventing and managing chronic diseases such as hypertension and emerging infectious diseases such as coronavirus disease 2019 (COVID-19). However, widespread gaps in the quality of primary health care still exist. In this Review, we aim to identify the causes for this poor quality, and provide policy recommendations. System challenges include: the suboptimal education and training of primary health-care practitioners, a fee-for-service payment system that incentivises testing and treatments over prevention, fragmentation of clinical care and public health service, and insufficient continuity of care throughout the entire health-care system. The following recommendations merit consideration: (1) enhancement of the quality of training for primary health-care physicians, (2) establishment of performance accountability to incentivise high-quality and high-value care; (3) integration of clinical care with the basic public health services, and (4) strengthening of the coordination between primary health-care institutions and hospitals. Additionally, China should consider modernising its primary health-care system through the establishment of a learning health system built on digital data and innovative technologies.

2017年10月25日 ,《柳叶刀》杂志在线发表了两篇有关我国高血压管理现状的文章 [1,2],揭示了我国目前高血压管理的三大突出问题,明确了亟待改善的靶点,为尽快解决这些问题提供了可靠的数据支撑.本文将从研究的数据来源和主要结果入手,解读研究的重要公共卫生意义.

OBJECTIVE:To assess the test-retest reliability and criterion validity of the Simplified Chinese-character version of the International Physical Activity Questionnaire Long form (IPAQ-L) in urban community-dwelling adults in Hanghzou, China.METHODS:A total of 158 eligible participants aged 25-59 years from 6 neighbourhoods in two central districts of Hangzhou completed the IPAQ-L questionnaire twice within a 7-day interval. Half of the subjects wore pedometers during the first 7 days. Test-retest reliability was examined by comparing the first (Day 1) and the second (Day 9) survey of IPAQ-L. Criterion validity was assessed by comparing IPAQ-L with pedometer data.RESULTS:Modest to good test-retest reliability was found with intraclass correlation coefficients of 0.67 for total PA, 0.37 to 0.73 for specific dimensions, and 0.56 to 0.71 for different intensities of PA. Total PA measured by IPAQ-L was moderately correlated with exercise levels (partial r = 0.27, P = 0.020) and walking distance (partial r = 0.31, P = 0.007), which were measured by a pedometer, after adjusting for gender, age, educational attainment and employment status.CONCLUSION:Our results indicate that the IPAQ-L is a reliable and validated measure for assessing physical activity levels in this population and possibly the adult population in other mainland Chinese cities.

Background Around 200 million adults in China have hypertension, but few are treated or achieve adequate control of their blood pressure. Available and affordable medications are important for successfully controlling hypertension, but little is known about current patterns of access to, and use of, antihypertensive medications in Chinese primary health care. Methods We used data from a nationwide cross-sectional survey (the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project primary health care survey), which was undertaken between November, 2016 and May, 2017, to assess the availability, cost, and prescription patterns of 62 antihypertensive medications at primary health-care sites across 31 Chinese provinces. We surveyed 203 community health centres, 401 community health stations, 284 township health centres, and 2474 village clinics to assess variation in availability, cost, and prescription by economic region and type of site. We also assessed the use of high-value medications, defined as guideline-recommended and low-cost. We also examined the association of medication cost with availability and prescription patterns. Findings Our study sample included 3362 primary health-care sites and around 1 million people (613 638 people at 2758 rural sites and 478 393 people at 604 urban sites). Of the 3362 sites, 8.1% (95% CI 7.2-9.1) stocked no antihypertensive medications and 33.8% (32.2-35.4) stocked all four classes that were routinely used. Village clinics and sites in the western region of China had the lowest availability. Only 32.7% (32.2-33.3) of all sites stocked high-value medications, and few high-value medications were prescribed (11.2% [10.9-11.6] of all prescription records). High-cost medications were more likely to be prescribed than low-cost alternatives. Interpretation China has marked deficiencies in the availability, cost, and prescription of antihypertensive medications. High-value medications are not preferentially used. Future efforts to reduce the burden of hypertension, particularly through the work of primary health-care providers, will need to improve access to, and use of, antihypertensive medications, paying particular attention to those with high value.

Summary Background Hypertension is common in China and its prevalence is rising, yet it remains inadequately controlled. Few studies have the capacity to characterise the epidemiology and management of hypertension across many heterogeneous subgroups. We did a study of the prevalence, awareness, treatment, and control of hypertension in China and assessed their variations across many subpopulations. Methods We made use of data generated in the China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE) Million Persons Project from Sept 15, 2014, to June 20, 2017, a population-based screening project that enrolled around 1·7 million community-dwelling adults aged 35–75 years from all 31 provinces in mainland China. In this population, we defined hypertension as systolic blood pressure of at least 140 mm Hg, or diastolic blood pressure of at least 90 mm Hg, or self-reported antihypertensive medication use in the previous 2 weeks. Hypertension awareness, treatment, and control were defined, respectively, among hypertensive adults as a self-reported diagnosis of hypertension, current use of antihypertensive medication, and blood pressure of less than 140/90 mm Hg. We assessed awareness, treatment, and control in 264 475 population subgroups—defined a priori by all possible combinations of 11 demographic and clinical factors (age [35–44, 45–54, 55–64, and 65–75 years], sex [men and women], geographical region [western, central, and eastern China], urbanity [urban vs rural], ethnic origin [Han and non-Han], occupation [farmer and non-farmer], annual household income [< ¥10 000, ¥10 000–50 000, and ≥¥50 000], education [primary school and below, middle school, high school, and college and above], previous cardiovascular events [yes or no], current smoker [yes or no], and diabetes [yes or no]), and their associations with individual and primary health-care site characteristics, using mixed models. Findings The sample contained 1 738 886 participants with a mean age of 55·6 years (SD 9·7), 59·5% of whom were women. 44·7% (95% CI 44·6–44·8) of the sample had hypertension, of whom 44·7% (44·6–44·8) were aware of their diagnosis, 30·1% (30·0–30·2) were taking prescribed antihypertensive medications, and 7·2% (7·1–7·2) had achieved control. The age-standardised and sex-standardised rates of hypertension prevalence, awareness, treatment, and control were 37·2% (37·1–37·3), 36·0% (35·8–36·2), 22·9% (22·7–23·0), and 5·7% (5·6–5·7), respectively. The most commonly used medication class was calcium-channel blockers (55·2%, 55·0–55·4). Among individuals whose hypertension was treated but not controlled, 81·5% (81·3–81·6) were using only one medication. The proportion of participants who were aware of their hypertension and were receiving treatment varied significantly across subpopulations; lower likelihoods of awareness and treatment were associated with male sex, younger age, lower income, and an absence of previous cardiovascular events, diabetes, obesity, or alcohol use (all p<0·01). By contrast, control rate was universally low across all subgroups (<30·0%). Interpretation Among Chinese adults aged 35–75 years, nearly half have hypertension, fewer than a third are being treated, and fewer than one in twelve are in control of their blood pressure. The low number of people in control is ubiquitous in all subgroups of the Chinese population and warrants broad-based, global strategy, such as greater efforts in prevention, as well as better screening and more effective and affordable treatment. Funding Ministry of Finance and National Health and Family Planning Commission, China.

Introduction China has pioneered advances in primary health care (PHC) and public health for a large and diverse population. To date, the current state of PHC in China has not been subjected to systematic assessments. Understanding variations in primary care services could generate opportunities for improving the structure and function of PHC. Methods and analysis This paper describes a nationwide PHC study (PEACE MPP Primary Health Care Survey) conducted across 31 provinces in China. The study leverages an ongoing research project, the China Patient-centered Evaluative Assessment of Cardiac Events (PEACE) Million Persons Project (MPP). It employs an observational design with document acquisition and abstraction and in-person interviews. The study will collect data and original documents on the structure and financing of PHC institutions and the adequacy of the essential medicines programme; the education, training and retention of the PHC workforce; the quality of care; and patient satisfaction with care. The study will provide a comprehensive assessment of current PHC services and help determine gaps in access and quality of care. All study instruments and documents will be deposited in the Document Bank as an open-access source for other researchers. Ethics and dissemination The central ethics committee at the China National Centre for Cardiovascular Disease (NCCD) approved the study. Written informed consent has been obtained from all patients. Findings will be disseminated in future peer reviewed papers, and will inform strategies aimed at improving the PHC in China. Trial registration number NCT02953926

Objective:To determine current rates and temporal trends of statin application,and to analyze factors associated with the lack of any statin therapy among hospitalized patients with acute myocardial infarction (AMI) in eastern rural China from 2001 to 2011.Method:A representative sample of patients in eastern rural China admitted to hospital for AMI was created from a two-stage random sampling.In the first phase,a simple random-sampling procedure was used to identify participating hospitals.In the second stage,we selected patients admitted to each participating hospitals for AMI in 2001,2006,and 2011 with a systematic sampling approach.Then we obtained clinical information via central medical record abstraction for each patient.For analysis of inhospital statin rates,we used multilevel logistical regression models with generalized estimating equations.Result:We sampled 35 hospitals (32 participated in the study) and identified 2 926 patients eligible for statin therapy to determine statin use.Between 2001 and 2011,statin use among hospitalized patients with AMI increased from 15.48％ in 2001 to 65.42％ in 2006 and 88.36％ in 2011(P＜0.001 for trend).In logistic regression,patients with chest pain (OR=2.11;95％CI:1.27-3.52,P=0.004),hypertension (OR=I.92;95％CI:1.28-2.86,P=0.001) were more likely to receive statin therapy.On the contrary,women (OR=0.66;95％CI:0.44-0.99,P=0.044),patients with hemorrhagic stroke (OR=0.39;95％CI:0.15-0.96,P=0.041),coronary heart disease (OR=0.46;95 ％ CI:0.26-0.83,P=0.009) were less likely to receive statin therapy.Application of statin use was significantly increased among all LDL-C groups (P＜0.001 for trend).Patients with lower LDL-C were less likely to be treated with statin,and patents without LDL-C measured had the lowest rate.Conclusion:During the past decade in eastern urban China,the use of statin therapy has dramatically increased.However,gaps still persisted among guideline and clinical practice.Initiatives promoting the use of statin therapy would support further improvements in practice.

Objective: To explore the application and affecting factors of clopidogrel loading therapy in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) in china in 2006 and 2011. Methods: Based on “China patient-centered evaluative assessment of cardiac events retrospective study of acute myocardial infarction”, we collected clinical information of STEMI patients with PCI in 2006, 2011 and analyzed clopidogrel loading therapy status in different years and different hospitals. According to clopidogrel doses, the patients were divided into 2 groups: Clopidogrel 300mg group, the patients received a single dose of clopidogrel ≥300mg while <450mg and Clopidogrel 600mg group, the patients received a single dose of clopidogrel ≥450mg while ≤600mg. The relevant factors affecting clopidogrel loading therapy status were identiifed by binary Logistic regression analysis. Results: A total of 2481 eligible patients were enrolled and their mean age was (60.9 ± 12.0) years including 21.4%female. From 2006 to 2011, the overall application of clopidogrel loading was (51.0% vs 47.4%), the ratio for patients in Clopidogrel 300mg group was (43.1% vs 39.2%), in Clopidogrel 600mg group was (7.8% vs 8.2%), allP>0.05. In 2006, the hospital median rate of clopidogerl application was 44.4% (IQR 21.8% to 69.0%) and in 2011, it was 48.1% (IQR 25.0% to 70.8%),P=0.940. Binary logistic regression analysis showed that the patients were admitted within 12 hours of onset, with primary PCI and treated in central region had the higher rates of clopidogrel loading therapy. Conclusion: Clopidogrel loading therapy was seriously inadequate in STEMI patients with PCI, variation was across hospitals and the status was similar between 2006 and 2011. Clopidogrel loading therapy should be improved.

Objective: To assess the trends in clinical characteristics, treatment, and outcomes for hospitalized patients undergoing percutaneous coronary intervention (PCI) in central-western urban hospitals of China in 2001, 2006 and 2011. Methods: We used a 2-stage, random sampling strategy to create a Chinese central-western urban hospital representative sample of 2152 patients undergoing PCI at 26 hospitals in China PEACE- retrospective CathPCI study and calculated the weighted data of clinical information in each year. Results: Between 2001 and 2011, the admission rate for PCI increased by 46 folds. Compared with 2001, the patients undergoing PCI were more likely to be female, older than 80 years, and to have history of diabetes, dyslipidemia and PCI in 2011. The proportion of trans-radial PCIs increased from 3.5% in 2001 to 87.6% in 2011 (Ptrend < 0.0001); the proportion of drug eluting stents (DES) among all the implanted stents increased from 16.4% in 2001 to 95.7% in 2011 (Ptrend < 0.0001), largely due to increased use of domestic DES. Less than 5% of medical record of admission for PCI documented door time&nbsp;and balloon time. The median length of stay decreased from 13 days in 2001 to 10 days in 2011 (Ptrend < 0.0001). In-hospital mortality did not change signiifcantly, but both any bleeding and access bleeding events were decreased signiifcantly over time (Ptrend < 0.05). Conclusion: There has been a rapid increase in the volume and significant change in treatment patterns of PCI over the 10-year period from 2001 to 2011 in Chinese central-western urban hospitals. We identiifed quality gaps that represent opportunities to improve medical care.

Introduction: While high blood pressure (BP) is a leading risk factor for cardiovascular diseases, little is known about the current status of treatment and BP control in China. This study aims to characterize the patterns of antihypertensive medication use and BP control in a recent Chinese national screening project. Methods: During the pilot phase of the China PEACE (Patient-Centered Evaluative Assessment of Cardiac Events) Million Persons Project, 384,234 adults aged 40-75 years were enrolled from the general population in four provinces in China between 2014-2015. We describe the prevalence, awareness, treatment, and control of hypertension in the study population, assess antihypertensive medication use, and characterize patients with uncontrolled hypertension using multivariate regression models. Hypertension was defined as BP ≥140/90mmHg, current antihypertensive medication use, or prior hypertension diagnosis. Awareness and control were defined as self-reported prior diagnosis and BP<140/90 mmHg, respectively, among those with hypertension. Results: The prevalence of hypertension in middle-aged Chinese adults was 43.7%; the awareness, treatment, and control of hypertension were 38.6%, 28.2%, and 8.2% (Figure). Among patients receiving antihypertensive medication, 85.5% used one medication and 13.5% used two. Calcium channel blockers (CCB) were most commonly used (56.1%), followed by angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) (19.6%); CCB plus ACEI/ARB was the most commonly used combination therapy regimen (7.6%). Men, lower income, less education, and obesity were associated with uncontrolled hypertension (all p values<0.05). Conclusions: Awareness, treatment, and control of hypertension were low in middle-aged Chinese adults, far lower than those in the United States. Improving BP control in China will likely require improving diagnosis and more aggressive treatment.

OBJECTIVE:To explore the association between walking time and the perception of built environment among local adults in Hangzhou.METHODS:Through multistage stratified random sampling, a total of 1 440 urban residents aged 25-59 years were surveyed in Hangzhou by face-to face interview in 2012. The international physical activity questionnaire-long version (IPAQ-L) was used to assess the physical activity levels, including walking time in the past week. Neighborhood Environment Walkability Scale-Abbreviated (NEWS-A) was used to obtain information about their perception of built environment. Multiple logistic regression was applied to estimate the relationship between waking and the perception of built environment.RESULTS:Among the local adults in Hangzhou, the median of total physical activity was 2 766 met·min⁻¹·week⁻¹, the average walking time per week was 90 min for leisure and 100 min for transportation respectively. After controlling the age, marital status, BMI, educational level, employment, community type and the total PA scores, the leisure-time walking was negatively related to the accessibility to stores, facilities and other things for both man (OR=0.764, 95% CI: 0.588-0.992) and woman (OR=0.633, 95% CI: 0.481-0.833). In sex specific analysis, the leisure-time walking was negatively related with the residential density (OR=0.997, 95% CI: 0.996-0.999) while transportation related walking was positively related with walking/cycling way scores (OR=1.537, 95% CI: 1.138-2.075) in females. In contrast, there were no significant associations between perception of built environment and transportation related walking in males.CONCLUSION:Improving the built environment, such as the walking/cycling way, might be useful to increase the transportation related walking time for adults. The sex specific differences need to be considered in the environment intervention for walking promotion.

Introduction Numerous studies have reported a strong inverse association between BMI and physical activity in western populations. Recently, the association between BMI and physical activity has been considered bidirectional. This study aimed to examine the associations of body mass index (BMI) with physical activity and sedentary behavior and to explore whether those associations were modified by socio-demographic characteristics. Materials and Methods We conducted a multistage random sampling survey in three districts of Hangzhou, China, in 2012. The International Physical Activity Questionnaire long form was used to collect data regarding physical activity and sedentary behavior. A multilevel mixed-effects regression model was used to assess the associations of BMI with physical activity and sedentary behavior. Results A total of 1362 eligible people (624 men and 738 women, ages 23-59 years) completed the survey. People who are young or middle-aged and have the highest education level are the most inactive. Significant differences in the associations between physical activity and BMI across socio-demographic groups were identified (sex*BMI, P=0.018; age*BMI, P<0.001; education level*BMI, P=0.030). Women or individuals older than 50 had a higher level of physical activity with increasing BMI. There was no statistically significant association between BMI and sedentary behavior (P=0.450). Conclusions The associations between BMI and physical activity were modified by sex, age, and education level in Hangzhou, China.

OBJECTIVE:To understand the perceptions of physical activity-related built environment among urban adults in Hangzhou.METHODS:A face-to-face interview was conducted among the urban residents aged 25-59 years selected through multistage stratified random sampling in Hangzhou in 2012. The Neighborhood Environment Walkability Scale-Abbreviated (NEWS-A) was used to assess the perception of built environment among residents, including residential building density, the diversities of stores, facilities and others, the accessibility to public service, the street connectivity, walking/cycling facilities, aesthetics, traffic safety, and public security. The multilevel logistic regression model was used to assess the demographic characteristics, BMI and other factors' influence on people's perceptions.RESULTS:Among 1 362 local residents surveyed, no sex, martial status and occupation specific significant differences in the perception of built environment were found. After adjusting other factors, the age group 45-59 years was positively related to the score of street connectivity (OR=2.02, 95% CI: 1.30-3.15). The educational level of college or higher was positively associated with the score of residential building density (OR=1.97, 95% CI: 1.29-3.00) but negatively associated with the score of facility variety (OR=0.65, 95% CI: 0.43-0.97). Overweight or obesity was negatively related to the scores of walking/cycling ways (OR=0.67, 95%CI: 0.48-0.95) and public security (OR=0.75, 95% CI: 0.57-0.99). Compared with the class I residential area, the people in class III residential area had lower perception scores on facility diversity (OR=0.11, 95% CI: 0.04-0.30), accessibility to public service (OR=0.33, 95% CI: 0.11-0.95), street connectivity (OR=0.30, 95% CI: 0.11-0.86) and traffic safety (OR=0.39, 95% CI: 0.17-0.91).CONCLUSION:The perceptions of physical activity-related built environment was associated with age, educational level, BMI and residential area. The personal characteristics should be considered while performing environment intervention on physical activity.

Background Some aspects of the neighborhood built environment may influence residents’ physical activity, which in turn, affects their health. This study aimed to develop an urban built environment evaluation tool and conduct necessary reliability and validity tests. Methods A 41-item urban built environment scan tool was developed to objectively assess the neighborhood built environment features related to physical activity. Six neighborhoods in Hangzhou were selected from three types of administrative planning units. A pair of auditors independently assessed all of the 205 street segments at the same time. Half of the segments (n = 104) were audited twice by the same auditor after a two-week time interval. Inter-rater reliability was assessed by comparing the audits of paired observers, while intra-rater reliability was evaluated by comparing an auditor’s repeated assessments of the same segments. The construct validity was tested using factor analysis. Results The inter-rater reliability for most items was above 0.8. The intra-rater reliability for most items was above 0.4, and was lower than corresponding inter-rater reliability. Six factors were extracted by factor analysis and the factor loading matrix showed good construct validity. Conclusions The CUBEST is a reliable and valid instrument that can be used to assess the physical activity-related built environment in Hangzhou, and potentially other cities in China.

Background. Neighborhood built environment may influence residents' physical activity, which in turn, affects their health. This study aimed to determine the associations between perceived built environment and leisure-time physical activity in Hangzhou, China.Methods. 1440 participants aged 25-59 were randomly selected from 30 neighborhoods in three types of administrative planning units in Hangzhou. International Physical Activity Questionnaire long form and NEWS-A were used to obtain individual-level data. The China Urban Built Environment Scan Tool was used to objectively assess the neighborhood-level built environment. Multi-level regression was used to explore the relationship between perceived built environment variables and leisure-time physical activities. Data was collected in Hangzhou from June to December in 2012, and was analyzed in May 2013.Results. Significant difference between neighborhood random variations in physical activity was identified (P = 0.0134); neighborhood-level differences accounted for 3.0% of the variability in leisure-time physical activity. Male residents who perceived higher scores on access to physical activity destinations reported more involvement in leisure-time physical activity. Higher scores on perception of esthetic quality, and lower on residential density were associated with more time in leisure-time walking in women.Conclusions. The present study demonstrated that perceived urban built environment attributes significantly correlate with leisure-time physical activity in Hangzhou, China. (C) 2014 The Authors. Published by Elsevier Inc.

体力活动(physical activity)水平是影响个体健康重要的、可干预的因素之一[1].个体保持适当的体力活动水平能够有效降低诸多慢性病,如心血管疾病、呼吸系统疾病等的发病风险[2,3].建成环境(built environment)指人为建设改造的各种建筑物、场所,尤其指那些可以通过政策、人为行为改变的环境[4].建成环境不仅包括公园、公共绿地,还包括人行道、交通流量、公共场所的清洁和维护、社区及社会安全感、区域划分及土地综合利用、人口密度等各个方面[5].近年来,人们的关注点逐渐集中于建成环境与个体体力活动关系的探讨[6,7].国外研究显示[8,9],良好的运动环境会促进人们更多地进行体力活动.围绕建成环境与个体及人群健康间关系的研究证据必将成为日后健康城市建设、城市规划的重要决策依据.而在此类研究中,建成环境和体力活动的评价方法及其测量工具是影响研究真实性的一个重要环节. 关键词：建成环境;体力活动;信度;效度