Associations between Land-Use Patterns and Cardiovascular Disease Mortality in the Beijing—Tianjin–Hebei Megacity Region

Round 1

Reviewer 1 Report

The topic of the article is very relevant . The results and conclusions, received by the authors, can be useful not only in China, but also in other countries of the world.
The authors used a serious mathematical apparatus. Relevant statistics is provided. Results of the research are presented in a binding to maps; that makes them evident and practically useful. The conclusions, drawn in the article, are logical and well-proved.
The authors mention cardiovascular diseas among the most serious diseases, which are spread depending on territorial spatial land use patterns and are the  subjects  to studying. It would be desirable, that the authors expanded the list of the studied diseases, which is obviously much wider.

Minor editing of English language are recommended:

Line 139: It is recommended to write "We used spatial autocorrelation analysis in this study"  instead of "In this study, we utilized spatial autocorrelation analysis"

Line 150: It is offered to write "Both indicators vary from -1 to 1. "  instead of "Both indicators vary between -1 and 1. "

Author Response

Dear reviewer,

Thank you so much for your insightful comments and suggestions which have helped improve the manuscript. We have proofread the language and revised the wording in line 139 and line 150 considering your recommendations. If there are any further details or clarifications needed, please feel free to let us know.

Sincerely,

The authors.

Reviewer 2 Report

Review: Impact of Territorial Spatial Land Use Patterns on Cardiovascular Disease Mortality in the Beijing-Tianjin-Hebei Mega-City Region

Dear authors and editors,

The study focuses on the Beijing-Tianjin-Hebei mega-city region (BTH) to investigate the potential effects of the distribution patterns of the three spatial categories on public health. Thus, the paper proposes an impact assessment of land use patterns on cardiovascular disease (CVD) mortality. However, based on the proposed study and its outcome, the reviewer cannot see scientifically grounded arguments that would substantiate mentioned at least in lines 47-48: “Territorial spatial patterns are crucial in mitigating the risk of cardiovascular disease in mega-city regions.”. Moreover, many expressions are not clearly explained as well. More specifically:

1.     What do the authors mean by “territorial spatial land use patterns”? Territory, space and land are equal in this mentioned construct. At least in the Continental European context “land-use patterns” or land-use categories are used.

2.     Land-use patterns themselves do not influence anything, but their intensification due to infrastructure development, pressure of human activities etc. do, which is mentioned in lines 443-444 by the way.

3.     It is not evident from the study that the assessed impact targets in particular CVD mortality and its risk (lines 21, 47, 430-431).

4.     Also, several other expressions are not clear to the reviewer and makes difficult to read and understand the manuscript, e.g. optimising territorial spatial patterns (line 12), new territorial spatial management system (line 14), territorial space (line 51), China’s theory and practice system (line 53), ecological space includes natural space (line 56-57), China’s territorial space planning (line 62), multi-source spatio-temporal big data (line 108), final section before fourth section (lines 128-130), land use control (line 134), general spatial distribution (line 142), local spatial scale (line 144), “codes for single-factor spatial pattern and two-factor interactive spatial pattern in the spatial pattern indicator factor…” (lines 236-237), implementation of planning (line 419), decentralization of agricultural space/land (line 437, 457-458), space needs to be appropriately concentrated (lines 438-439), mentioned in lines 441-446, organically integrated…smooth flow of material and energy between various patch types (lines 451-452), internal biodiversity construction (line 454), tourist agriculture (lines 459-460), and mentioned in lines 467-469 needs reference.

5.     There are several mistakes in Table 1 (see PD, ED).

6.     Is the environmental health theory really developed by a research paper (see. line 48, reference [2])?

7.     There are some other objections.

In view of all the above-mentioned, I recommend to the editors to REJECT the manuscript for publishing as it has serious flaws to be avoided.

Wishing you the best of luck with your further research.

With best regards

The reviewer

Author Response

Dear reviewer,

Thank you for your insightful comments and suggestions which have helped improve the manuscript. We have carefully revised the manuscript in response to your query to make it more rigorous and understandable. Below are responses to specific comments.

• Reviewer comment 1: What do the authors mean by “territorial spatial land use patterns”? Territory, space and land are equal in this mentioned construct. At least in the Continental European context “land-use patterns” or land-use categories are used.
• Response: Thanks for this comment. We have now rephrased the term as “land-use patterns”. In Chinese, “territory spatial planning” is a term referring to the long-term planning and overall arrangement of land resources and space layout under the jurisdiction of Chinese government (https://0-doi-org.brum.beds.ac.uk/10.1016/j.landusepol.2021.105288). However, we agree that it is better to use a more acceptable term given that our method is not limited to be applied in China. Therefore, we replace this term by “land-use patterns” in the revision.
• Reviewer comment 2: Land-use patterns themselves do not influence anything, but their intensification due to infrastructure development, pressure of human activities etc. do, which is mentioned in lines 443-444 by the way.
• Response: Thanks for this comment. We agree with the reviewer’s viewpoint that land-use patterns do not cause residents’ CVD mortality directly. However, there are many studies have identified that land-use patterns are indirectly associated with CVD mortality through interventions in human activities, environmental quality, temperature, infrastructure development levels, and other factors (please see studies in the reference list, such as Velarde et al., 2007; Rhew et al., 2019; Michimi et al., 2013). We have revised the relevant literature in the introduction section and rephrased the texts with the word “association”.

In fact, the aim of this study is not to demonstrate a direct causal relationship between land-use patterns and CVD mortality but rather to illustrate their correlation from a geographical statistical perspective and explore the underlying mechanisms behind this correlation. Therefore, the research approach is to first identify significant associations between independent and dependent variables through statistical models. Subsequently, in the discussion section, we elaborate on the identified correlations by integrating model results, existing literature research findings, and the authors’ discussion. Due to the absence of causal inference techniques, we cannot assert the direct impact of land-use patterns. However, through empirical research methods, we can to some extent identify the association between land-use patterns and CVD mortality and extrapolate potential mechanisms.

We believe that uncovering the correlation between land-use patterns and CVD mortality is a meaningful research topic for two reasons:

First, the aforementioned correlation has been confirmed by a considerable amount of research. As discovered in this study through literature reviews in paragraph 3, the layout patterns of ecological, agricultural, and urban spaces are significantly associated with public health, including CVD. This provides a foundation for the approach taken in this study.

Second, China is currently undertaking nationwide planning and optimizing of land-use patterns, which will unprecedentedly impact the country’s ecological conservation, urban development, industrial growth, and reshape environmental exposure factors and human behavior related to CVD. Therefore, a systematic exploration of the relationship between land-use patterns and CVD mortality is beneficial for optimizing the benefits of land-use and supporting the government in formulating effective policies.

In accordance with the reviewer's suggestions and considering the above factors, we have made the following modifications to the content in the article.

(1)   We have thoroughly revised the paper to avoid using words indicating causal effects. For example, we have revised the title as “Association between Land-use Patterns and Cardiovascular Disease Mortality in the Beijing-Tianjin-Hebei Mega-City Region”, which avoid using the word of “impact”.

(2)   Accordingly, we have changed the expressions of causal effects by avoiding using words such as (impact, effects, affect, etc.). Instead, we use the words such as association, correlation, and relationship. Please see lines 112, 120, 271, 314, 402, etc.

• Reviewer comment 3: It is not evident from the study that the assessed impact targets in particular CVD mortality and its risk (lines 21, 47, 430-431).
• Response: Thank you for pointing out the expression issues in our manuscript. We think this comment is related to comment 2. As we mentioned in response to the previous comment, this study does not fundamentally infer a direct causal relationship between land-use patterns and CVD mortality but rather reveals their correlation. At the same time, this correlation specifically targets CVD mortality, as our model uses the dependent variable of CVD mortality data provided by the CDC. The calculation results of various models indicate statistically significant associations between multiple landscape pattern indices related to land-use patterns and the dependent variable.

On the other hand, as pointed out by the reviewer, there are certain flaws in the use of the concepts of CVD mortality and CVD risk in this paper. Our original intention was to consider the two as interchangeable and equivalent concepts, rather than implying risk brought about by CVD mortality. However, based on the reviewer's feedback, we recognize that risk encompasses not only the loss of life but also damage to health, economic losses, mental losses, etc., making its scope broader than CVD mortality. Therefore, we agree that the interchangeable use of these two concepts is not appropriate. In the latest version of the submitted manuscript, we have made comprehensive revisions to address this issue.

Line 21: the word “risk” has been revised as “mortality”.

Line 47: we revised this sentence and adjusted it to line 54-56. The word “risk” is used because it is based on the original reference.

Line 430-431: the word “risk” has been revised as “mortality”.

• Reviewer comment 4: Also, several other expressions are not clear to the reviewer and makes difficult to read and understand the manuscript, e.g. optimising territorial spatial patterns (line 12), new territorial spatial management system (line 14), territorial space (line 51), China’s theory and practice system (line 53), ecological space includes natural space (line 56-57), China’s territorial space planning (line 62), multi-source spatio-temporal big data (line 108), final section before fourth section (lines 128-130), land use control (line 134), general spatial distribution (line 142), local spatial scale (line 144), “codes for single-factor spatial pattern and two-factor interactive spatial pattern in the spatial pattern indicator factor…” (lines 236-237), implementation of planning (line 419), decentralization of agricultural space/land (line 437, 457-458), space needs to be appropriately concentrated (lines 438-439), mentioned in lines 441-446, organically integrated…smooth flow of material and energy between various patch types (lines 451-452), internal biodiversity construction (line 454), tourist agriculture (lines 459-460), and mentioned in lines 467-469 needs reference.
• Response: We also have made comprehensive revisions to avoid unclear expressions.

Line 12: “optimizing territorial spatial patterns” has been revised as “optimizing land-use patterns”.

Line 14: “new territorial spatial management system” has been revised as “China’s new land-use management system”.

Line 51, line 53: The sentence includes “territorial space” and “China’s theory and practice system” has been deleted and rewritten as: “There is a new land-use management system in China, which emphasizes the basic management objects are three types of spaces: ecological space, agricultural space, and construction space”.

Line 56-57: We realize that there is no explicit inclusion relation between ecological space and natural space, so we delete the wording of “natural space”.

Line 62: “China’s territorial space planning” has been revised as “planning and optimizing land use in China’s new land-use management system”.

Line 108: “multi-source spatio-temporal big data” has been revised as “multi-dimensional spatiotemporal big data”, which refers to large and complex datasets that encompass multiple dimensions, including both spatial and temporal elements. These datasets are characterized by their volume (big data), the inclusion of time-related (temporal) and location-related (spatial) information, and additional dimensions that could be various other attributes or features.

Line 128-130: This mistake has been revised.

Line 134: “land use control” has been revised as “land-use optimizing”.

Line 142: “general spatial distribution” has been revised as “overall spatial distribution”.

Line 144: “on a local spatial scale” refers to the relationship between the value of a geographic unit and the value of its neighbors, so we realized that the expression was repetitive, and we modified it by removing "on a local scale"(line 142-143).

Line 236-237: The annotation has been revised.

Line 419: “China's comprehensive implementation of territorial spatial planning” has been revised as “China’s new land-use management system”.

Line 437, 458-458: “decentralization of agricultural space/land” has been revised as “dispersion of agricultural space”.

Line 438-439: The expression of this sentence is not accurate. We have optimized it (line 438-439).

Line 441-446: The unclear expressions have been revised.

Line 451-452: We have modified the expression (line 451-452).

Line 454: “internal biodiversity construction” has been revised as “internal biodiversity”.

Line 459-460: “tourist agriculture” has been revised as “agritourism”.

Line 467-469: We have added proper reference for this sentence.

• Reviewer comment 5: There are several mistakes in Table 1 (see PD, ED).
• Response: The mistakes have been revised in Table 1.
• Reviewer comment 6: Is the environmental health theory really developed by a research paper (see. line 48, reference [2])?
• Response: There has been a mistake here. We have replaced the wrong reference by several accurate citations.
• Reviewer comment 7: There are some other objections.
• Response: We have carefully checked the manuscript again. Distinctions have been made between “land use” and “space”, “mortality” and “risk”, “effect” and “association”, etc. Additionally, we have optimized other presentation issues to make the manuscript more concise and easier to understand.

We deeply appreciate again for your thorough review and insightful feedback on our manuscript. Regardless of the final decision, we are grateful for the opportunity to improve our work through your comments and for the learning experience this process has provided.

Thank you for considering our request for a second review.

Sincerely,

The authors.

Reviewer 3 Report

The article submitted for review addresses the impact of territorial spatial land use patterns on cardiovascular disease (CVD) mortality in the Beijing-Tianjin-Hebei megacity region. CVD is currently the most important factor influencing mortality in China and worldwide. Therefore, looking for the relationship between CVD and the factors potentially affecting it is scientifically very important.

The article is very well written. It correctly presents the background of the research conducted, the research methods and tools, and the results of the analyses obtained. The conclusions of the research are well formulated and the recommendations are a logical consequence of the results obtained.

As the authors rightly point out, the results of the conducted research are not universal for different types of regions , which suggests that policy-makers need to adapt their policies to local conditions. It is therefore worth trying to improve the proposed research method in the future so that it can be more universal.

In conclusion, the reviewed article is very good. As it stands, it is suitable for publication.

Author Response

Dear reviewer,

Thank you very much for reviewing our manuscript and for your positive assessment. We appreciate your time and effort in evaluating our work. If there are any further details or clarifications needed, please feel free to let us know.

Sincerely,

The authors.

Round 2

Reviewer 2 Report

Dear Authors and Editors,

After receiving detailed explanations and responses to the reviewer's comments, especially, to 2-4, the reviewer agrees that the manuscript can be considered for publication.

I wish you the best of luck with your research and thank you for conducting this study.

Best regards, the reviewer