Neighbourhood walkability and mortality: Findings from a 15-year follow-up of a nationally representative cohort of Canadian adults in urban areas. (March 2022)

• Record Type: Journal Article
• Authors: Lang, Justin J.; Pinault, Lauren; Colley, Rachel C.; Prince, Stephanie A.; Christidis, Tanya; Tjepkema, Michael; Crouse, Dan L.; de Groh, Margaret; Ross, Nancy; Villeneuve, Paul J.
• Is Part Of: Environment international. Volume 161(2022)
• Publication Date: 2022-03
• Subjects: Neighbourhood walkability -- Cardiovascular disease -- Mortality -- Cohort; Environmental protection -- Periodicals; Environmental health -- Periodicals; Environmental monitoring -- Periodicals; Environmental Monitoring -- Periodicals; Environnement -- Protection -- Périodiques; Hygiène du milieu -- Périodiques; Environnement -- Surveillance -- Périodiques; Environmental health; Environmental monitoring; Environmental protection; Periodicals; 333.705
• DOI: 10.1016/j.envint.2022.107141
• Languages: English
• ISSNs: 0160-4120

Abstract

Highlights: Living in the most walkable neighbourhoods was associated with small significant reductions in mortality. The strongest protective effects were observed in those who belonged to the lowest socioeconomic groups. Walkable neighbourhoods have the potential to create a small but wide reaching impact on population health. Abstract: Background: Using a nationally representative cohort of Canadian adults, we assessed associations between neighbourhood walkability and cause-specific mortality and investigated whether they differed by socioeconomic status. Methods: The study population was drawn from the 2001 Canadian Census Health and Environment Cohort, which contains individual-level data from a random sample of 20% of Canadian households mandated to complete the long-form census. We included those aged ≥ 25 years at baseline who lived in urban and suburban areas. The national death registry was used to ascertain annual vital status. Linkages to annual income tax data provided place of residence. The Canadian Active Living Environments, a national index that summarizes walkability across Canadian neighbourhoods, was assigned to individuals' residential history. The Cox proportional hazards model was used to assess associations between walkability and cause-specific mortality. Results: A total of 1.8 million participants (52.5% female) accrued 27.3 million person-years and 265 710 deaths during the 15-year follow-up. The adjusted hazard ratio (HR) for living in a highly walkable neighbourhood relative to living in the least walkable neighbourhoods was associated with a 9% (HR: 0.91 [0.88, 0.95]) and 3% (HR: 0.97 [0.94, 0.99]) reduced risk of cardiovascular and all non-accidental mortality, respectively. The strongest benefits of walkability were found among individuals within the lowest education and household income categories, and who lived in the most deprived neighbourhoods. There were no significant associations (most [class 5] versus least [class 1] walkable HR: 0.84 [0.61–1.16]) seen for accidental traffic mortality. Conclusions: Canadian adults who live in walkable neighbourhoods have lower rates of cardiovascular and non-accidental mortality, with the greatest benefits seen in those from the lowest socioeconomic groups.