Sandra India-Aldana1, Andrew G Rundle2, Anne Zeleniuch-Jacquotte1, James W Quinn3, Byoungjun Kim2, Yelena Afanasyeva1, Tess V Clendenen1, Karen L Koenig1, Mengling Liu4,5, Kathryn M Neckerman3, Lorna E Thorpe1, Yu Chen1,5. 1. From the Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, NY. 2. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. 3. Columbia Population Research Center, Columbia University, New York, NY. 4. Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, NY. 5. Department of Environmental Medicine, New York University Grossman School of Medicine, New York, NY.
Abstract
BACKGROUND: There is a paucity of prospective cohort studies evaluating neighborhood walkability in relation to the risk of death. METHODS: We geocoded baseline residential addresses of 13,832 women in the New York University Women's Health Study (NYUWHS) and estimated the Built Environment and Health Neighborhood Walkability Index (BEH-NWI) for each participant circa 1990. The participants were recruited from 1985 to 1991 in New York City and followed for an average of 27 years. We conducted survival analyses using Cox proportional hazards models to assess the association between neighborhood walkability and risk of death from any cause, obesity-related diseases, cardiometabolic diseases, and obesity-related cancers. RESULTS: Residing in a neighborhood with a higher neighborhood walkability score was associated with a lower mortality rate. Comparing women in the top versus the lowest walkability tertile, the hazards ratios (and 95% CIs) were 0.96 (0.93, 0.99) for all-cause, 0.91 (0.86, 0.97) for obesity-related disease, and 0.72 (0.62, 0.85) for obesity-related cancer mortality, respectively, adjusting for potential confounders at both the individual and neighborhood level. We found no association between neighborhood walkability and risk of death from cardiometabolic diseases. Results were similar in analyses censoring participants who moved during follow-up, using multiple imputation for missing covariates, and using propensity scores matching women with high and low neighborhood walkability on potential confounders. Exploratory analyses indicate that outdoor walking and average BMI mediated the association between neighborhood walkability and mortality. CONCLUSION: Our findings are consistent with a protective role of neighborhood walkability in obesity-related mortality in women, particularly obesity-related cancer mortality.
BACKGROUND: There is a paucity of prospective cohort studies evaluating neighborhood walkability in relation to the risk of death. METHODS: We geocoded baseline residential addresses of 13,832 women in the New York University Women's Health Study (NYUWHS) and estimated the Built Environment and Health Neighborhood Walkability Index (BEH-NWI) for each participant circa 1990. The participants were recruited from 1985 to 1991 in New York City and followed for an average of 27 years. We conducted survival analyses using Cox proportional hazards models to assess the association between neighborhood walkability and risk of death from any cause, obesity-related diseases, cardiometabolic diseases, and obesity-related cancers. RESULTS: Residing in a neighborhood with a higher neighborhood walkability score was associated with a lower mortality rate. Comparing women in the top versus the lowest walkability tertile, the hazards ratios (and 95% CIs) were 0.96 (0.93, 0.99) for all-cause, 0.91 (0.86, 0.97) for obesity-related disease, and 0.72 (0.62, 0.85) for obesity-related cancer mortality, respectively, adjusting for potential confounders at both the individual and neighborhood level. We found no association between neighborhood walkability and risk of death from cardiometabolic diseases. Results were similar in analyses censoring participants who moved during follow-up, using multiple imputation for missing covariates, and using propensity scores matching women with high and low neighborhood walkability on potential confounders. Exploratory analyses indicate that outdoor walking and average BMI mediated the association between neighborhood walkability and mortality. CONCLUSION: Our findings are consistent with a protective role of neighborhood walkability in obesity-related mortality in women, particularly obesity-related cancer mortality.
Authors: Karin Nelson; Leslie Taylor; Nicole Lurie; José Escarce; Lynne McFarland; Stephan D Fihn Journal: J Gen Intern Med Date: 2011-04-16 Impact factor: 5.128
Authors: Geetanjali R Kamath; Anne S Renteria; Sundar Jagannath; Emily Jane Gallagher; Samir Parekh; Nina A Bickell Journal: Ann Epidemiol Date: 2020-05-15 Impact factor: 3.797