Abstract
SummaryBackgroundObservational studies have identified a link between unfavourable neighbourhood characteristics and increased risk of morbidity, but it is unclear whether changes in neighbourhoods affect future disease risk. We used a data-driven approach to assess the impact of neighbourhood modification on 79 health outcomes.MethodsIn this prospective cohort study, we used pooled, individual-level data from two Finnish cohort studies: the Health and Social Support study and the Finnish Public Sector study. Neighbourhood characteristics (mean educational level, median income, and employment rate of residents, and neighbourhood green space) and individual lifestyle factors of community-dwelling individuals were assessed at baseline (at different waves starting between 1998 and 2013). We repeated assessment of neighbourhood characteristics and lifestyle factors approximately 5 years from each baseline assessment, after which follow-up began for health conditions diagnosed according to the WHO International Classification of Diseases for 79 common health conditions using linkage to electronic health records. We used Cox proportional hazard regression models to compute adjusted hazard ratios (HRs) of incident disease associated with neighbourhood characteristics and changes in neighbourhood characteristics over time and logistic regression analysis to compute adjusted odds of association between changes in neighbourhood characteristics and individual lifestyle factors.Findings114 786 individuals (87 012 [75·8%] women; mean age 44·4 years [SD 11·1]) had complete data and were included in this cohort study. During 1·17 million person-years at risk, we recorded 164 368 new-onset health conditions and 3438 deaths. Favourable changes in neighbourhood characteristics were associated with reduced risk of all-cause mortality and incidence of 19 specific health conditions. Unfavourable changes were correspondingly associated with increased risk of mortality and 27 specific health conditions. Among participants who did not move residence during the observation period, relative to individuals who continually lived in disadvantaged neighbourhoods, those who experienced favourable modifications in neighbourhood characteristics had a lower risk of future diabetes (HR 0·84, 95% CI 0·75–0·93), stroke (0·49, 0·29–0·83), skin disease (0·72, 0·53–0·97), and osteoarthritis (0·87, 0·77–0·99). Living in a neighbourhood with improving characteristics was also associated with improvements in individual-level health-related lifestyle factors. Among participants who lived in advantaged residential environments at baseline, unfavourable changes in neighbourhood characteristics were associated with an increased risk of diabetes, stroke, skin disease, and osteoarthritis compared with individuals who lived in advantaged neighbourhoods throughout the study period.InterpretationFavourable modifications to residential neighbourhoods showed robust, longitudinal associations with a range of improvements in health outcomes, including improved health behaviours and reduced risk of cardiometabolic, infectious, and orthopaedic conditions.FundingUK Medical Research Council, US National Institute on Aging, NordForsk, and Academy of Finland.
Highlights
Residential neighbourhoods might influence human health by affecting social cohesion and access to health care, healthy foods, and education, availability of recrea tional facilities, and environmental exposures
We found that compared with people con tinually living in disadvantaged neighbourhoods, those who resided throughout the study in neighbourhoods that transitioned over time toward more favourable characteristics, in terms of educational levels, income, and employment rates of residents and improvements in green space, had a lower future risk of diabetes, stroke, skin disease, and osteoarthritis
Among individuals who lived in advantaged residential environments at baseline, unfavourable modifications to neighbourhoods were associated with increased risk of diabetes, stroke, skin disease, and osteoarthritis
Summary
Residential neighbourhoods might influence human health by affecting social cohesion and access to health care, healthy foods, and education, availability of recrea tional facilities, and environmental exposures. Findings from observational studies suggest that unfavourable neighbourhood characteristics can have a number of health effects, including an association between neigh bourhood socioeconomic disadvantage and increased risk of diabetes, cardiovascular disease, and behavioural disorders;[1,2,3,4,5] and an associa tion between outdoor pollution and an excess of cardiovascular and cerebrovascular diseases and respiratory conditions such as asthma.[6,7] An association between absence of residential green space and risk of metabolic syndrome, poor mental health, and premature mortality has been reported.[8,9,10,11,12] Further more, various other characteristics of built environments (eg, access to public transport, walkability, and location of employment and services) might be associated with human health.[13,14,15]. Few longitudinal studies assessed whether favourable and unfavourable changes in neighbourhood characteristics were associated with corresponding changes in health
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