Mapping the (un)healthy city: Proximity to urban facilities and chance of premature mortality from myocardial infarction in São Paulo city

Abstract

Applied research in healthy cities is often based on empirical investigations of the association between the built environment and health outcomes using spatial analysis. We investigated the influence of proximity to urban facilities on the occurrence of early deaths from myocardial infarction (age <60 years) in the city of São Paulo, with cause of death determined by autopsy. The study data were extracted from interviews applied to relatives/caregivers of 458 deceased autopsied at the Death Verification Service, collecting information on demographic characteristics, residential address, life habits and previous health conditions. After geocoding the residential addresses of the deceased, the distances to different urban facilities were calculated. The existence of an association between the odds of death from myocardial infarction aged <60 years versus ≥60 years and distance to urban facilities was assessed by fitting logistic regression models. The results showed a significant association between these distances and the odds of early death from infarction. More specifically, when distances to different facilities were halved, the odds of death at <60 years were reduced by a factor of 0.78 (−22 %) for community clubs; 0.73 (−27 %) for sports centers; and by 0.80 (20 %) for cycle paths). These results indicate the potential of interventions to benefit human health through the formulation of spatially-integrated public policies in cities.