Data_Sheet_1_Investigating the role of the built environment, socio-economic status, and lifestyle factors in the prevalence of chronic diseases in Mashhad: PLS-SEM model.docx

BackgroundChronic diseases remain a significant contributor to both mortality and disability in our modern world. Physical inactivity and an unhealthy diet are recognized as significant behavioral risk factors for chronic diseases, which can be influenced by the built environment and socio-economic status (SES). This study aims to investigate the relationship between the built environment, SES, and lifestyle factors with chronic diseases.
MethodsThe current study was conducted in Mashhad’s Persian cohort, which included employees from Mashhad University of Medical Sciences (MUMS). In the study, 5,357 participants from the cohort were included. To assess the state of the built environment in Mashhad, a Geographic Information System (GIS) map was created for the city and participants in the Persian Mashhad study. Food intake and physical exercise were used to assess lifestyle. A food frequency questionnaire (FFQ) was used to assess food intake. To assess food intake, the diet quality index was computed. To assess the link between variables, the structural model was created in accordance with the study’s objectives, and partial least square structural equation modeling (PLS-SEM) was utilized.
ResultsThe chronic diseases were positively associated with male sex (p < 0.001), married (p < 0.001), and higher age (p < 0.001). The chronic diseases were negatively associated with larger family size (p < 0.05), higher SES (p < 0.001), and higher diet quality index (DQI) (p < 0.001). No significant relationship was found between chronic disease and physical activity.
ConclusionFood intake and socioeconomic status have a direct impact on the prevalence of chronic diseases. It seems that in order to reduce the prevalence of chronic diseases, increasing economic access, reducing the class gap and increasing literacy and awareness should be emphasized, and in the next step, emphasis should be placed on the built environment.

背景 慢性疾病仍是当今世界致死与致残的重要诱因。体力活动不足与不健康饮食被公认为慢性疾病的重要行为风险因素，而这些风险因素可受建成环境（built environment）与社会经济地位（socio-economic status, SES）的影响。本研究旨在探究建成环境、社会经济地位以及生活方式因素与慢性疾病之间的关联。

方法 本研究基于马什哈德波斯队列开展，研究对象涵盖马什哈德医科大学（Mashhad University of Medical Sciences, MUMS）的教职工。本研究共纳入该队列中的5357名参与者。为评估马什哈德的建成环境状况，本研究为该城市及波斯马什哈德研究的参与者构建了地理信息系统（Geographic Information System, GIS）地图。通过饮食摄入与体育锻炼情况评估参与者的生活方式：采用食物频率问卷（food frequency questionnaire, FFQ）评估饮食摄入情况，并计算饮食质量指数以进一步评估饮食摄入质量。为探究各变量间的关联，本研究根据研究目标构建了结构模型，并采用偏最小二乘结构方程模型（partial least square structural equation modeling, PLS-SEM）进行分析。

结果 慢性疾病与男性性别（p<0.001）、已婚状态（p<0.001）以及更高的年龄（p<0.001）呈正相关；与更大的家庭规模（p<0.05）、更高的社会经济地位（p<0.001）以及更高的饮食质量指数（diet quality index, DQI）（p<0.001）呈负相关。未发现慢性疾病与体育锻炼之间存在显著关联。

结论 饮食摄入与社会经济地位对慢性疾病的患病率具有直接影响。由此可见，若要降低慢性疾病的患病率，应优先强调提升经济可及性、缩小阶层差距以及提高文化水平与健康认知，后续则应重点关注建成环境因素。