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Cited by 35Urban Transport and AccessibilityPhysical Activity and HealthAir Quality and Health Impacts

Association Between Active Commuting and Incident Cardiovascular Diseases in Chinese: A Prospective Cohort Study

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Fan, Mengyu, Lv, Jun, Yu, Canqing, Guo, Yu, Bian, Zheng, Yang, Songchun, Yang, Ling, Chen, Yiping +8 more·2019·Journal of the American Heart Association
DOI 10.1161/jaha.119.012556PMC PMC6818036
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Abstract

Background: Active commuting is related to a higher level of physical activity but more exposure to ambient air pollutants. With the rather serious air pollution in urban China, we aimed to examine the association between active commuting and risk of incident cardiovascular disease in the Chinese population. Methods and Results: A total of 104 170 urban commuters without major chronic diseases at baseline were included from China Kadoorie Biobank. Self‐reported commuting mode was defined as nonactive commuting, work at home or near home, walking, and cycling. Multivariable Cox regression was used to examine associations between commuting mode and cardiovascular disease. Overall, 47.2% of the participants reported nonactive commuting, 13.4% reported work at home or work near home, 20.1% reported walking, and 19.4% reported cycling. During a median follow‐up of 10 years, we identified 5374 incidents of ischemic heart disease, 664 events of hemorrhagic stroke, and 4834 events of ischemic stroke. After adjusting for sex, socioeconomic status, lifestyle factors, sedentary time, body mass index, comorbidities, household air pollution, passive smoking, and other domain physical activity, walking (hazard ratio, 0.90; 95% CI, 0.84–0.96) and cycling (hazard ratio, 0.81; 95% CI, 0.74–0.88) were associated with a lower risk of ischemic heart disease than nonactive commuting. Cycling was associated with a lower risk of ischemic stroke (hazard ratio, 0.92; 95% CI, 0.84–1.00). No significant association was found of walking or cycling with hemorrhagic stroke. The associations of commuting mode with major cardiovascular disease were consistent among men and women and across different levels of other domain physical activity. Conclusions: In urban China, cycling was associated with a lower risk of ischemic heart disease and ischemic stroke. Walking was associated with a lower risk of ischemic heart disease.

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Crossref · 10.1161/jaha.119.012556

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  • Among those 10 papers, 1 (10%) showed an effect of physical activity on ischemic stroke in men but not in women.

    “and 1 (10%)37 showed an effect in men but not women.37”

    From Sex Differences in Physical Activity and Incident Stroke: A Systematic Review (2022) · cites this paper as [37]

    The Results (Subgroup Analyses; page unavailable) say the associations were generally similar across sex subgroups, with no significant interaction by sex. The Discussion likewise says the associations with major cardiovascular diseases were consistent among men and women, contrary to the attributed men-only effect on ischemic stroke. (LLM, conf=0.90)

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  • Seven studies (37%) demonstrated no evidence for reduced risk of incident ischemic stroke associated with physical activity in women.

    “and 7 (37%) demonstrated no evidence for reduced risk of incident stroke associated with physical activity.30,34,37,42,48,56,65”

    From Sex Differences in Physical Activity and Incident Stroke: A Systematic Review (2022) · cites this paper as [37]

    The Results (Association Between Commuting Mode and CVDs; page unavailable) show no reduced ischemic-stroke risk for walking, which supports a narrower null finding. But they report an inverse association for cycling, and the Discussion says the associations were consistent among men and women. The source therefore does not support describing its ischemic-stroke findings in women as wholly showing no evidence of reduced risk. The seven-study count is the citing paper’s synthesis, not a finding attributed to this individual study. (LLM, conf=0.82)

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  • Few papers (n=3) reported testing interaction terms or conducting a hypothesis test of a sex by physical activity interaction for ischemic stroke, and one demonstrated a significant sex interaction (P for interaction <0.05).

    “Few papers (n=3) reported that they tested interaction terms or conducted a hypothesis test of a sex by physical activity interaction,32,37,48 and one demonstrated a significant sex interaction (P for interaction <0.05).37”

    From Sex Differences in Physical Activity and Incident Stroke: A Systematic Review (2022) · cites this paper as [37]

    The Methods (Statistical Analysis) say the study tested interactions between commuting mode and sex using likelihood-ratio tests. But the Results (Subgroup Analyses) report no significant sex interaction; the only significant interaction identified was for marital status (P=0.033). Thus the testing claim is supported, but a significant sex interaction is not supported by this paper. (LLM, conf=0.87)

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Cites

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Research works printed but not linked: 22

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Cited by

Sorted by citations

Authors
Fan, M., Lv, J., Yu, C., Guo, Y., Bian, Z., Yang, S., Yang, L., Chen, Y., Huang, Y., Chen, B., Fan, L., Chen, J., Chen, Z., Qi, L., Li, L., & the China Kadoorie Biobank Collaborative Group
Affiliations
  • Tulane University (US)
  • Peking University (CN)
  • Chinese Academy of Medical Sciences & Peking Union Medical College (CN)
  • University of Oxford (GB)
  • Hunan Provincial Center for Disease Control and Prevention (CN)
  • Henan Provincial Center for Disease Control and Prevention (CN)
  • China National Center for Food Safety Risk Assessment (CN)
Corresponding author
  • Qi, Lu
  • Li, Liming
ORCID
Venue
Journal of the American Heart Association
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2019-10-15
Volume
8
Issue
20
Pages
e012556-e012556
ISSN
2047-9980 (ISSN-L)
DOI
10.1161/jaha.119.012556
PMC
PMC6818036
OpenAlex
W2978112478
Cited by
35
References
3
Citations by year
2026: 1 · 2025: 2 · 2024: 9 · 2023: 6 · 2022: 7 · 2021: 7 · 2020: 2 · 2019: 1
FWCI
4.76
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Journal of the American Heart Association (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • Wellcome Trust (212946/Z/18/Z, 202922/Z/16/Z, 088158/Z/09/Z, 104085/Z/14/Z)
  • Medical Research Council (MC_UU_00017/1)
  • National Heart, Lung, and Blood Institute (R01HL071981, R21HL126024, R01HL034594)
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK100383, R01DK091718, R01DK078616, U01DK078616, UM1DK078616, R01DK115679)
Topics
  • Social Sciences › Transportation › Urban Transport and Accessibility
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
Keywords
active commuting, cardiovascular disease, cycling, walking, ischemic heart disease, ischemic stroke, hemorrhagic stroke, commuting modes, urban air pollution, physical activity, Chinese population
MeSH terms
Adult, Cardiovascular Diseases, China, Female, Follow-Up Studies, Humans, Life Style, Male, Middle Aged, Prospective Studies, Transportation, Urban Population, Exercise, Body Mass Index, Incidence, Walking, Self Report

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