Neighborhood Walkability and Mortality in a Prospective Cohort of Women

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BACKGROUND AND AIM: Neighborhood walkability (NW) may play a role in preventing chronic disease and increasing life expectancy. Evidence suggests that walking prevents obesity-related illness and mortality. Yet, there is paucity of long-term prospective studies evaluating community-level walkability characteristics in relation to the risk of death. Our aim is to assess the association between baseline measures of NW and risk of death in a large prospective cohort of women. METHODS: Baseline residential addresses of 13,832 women in the New York University Women’s Health Study (NYUWHS) were geo-coded and the Built Environment and Health Neighborhood Walkability Index (BEH-NWI) was estimated for each participant. The participants were recruited from 1985 to 1991 in New York City and followed up for an average of 27 years. We conducted survival analyses using Cox proportional hazards models to assess the association between BEH-NWI and risk of death from any cause, obesity-related diseases, cardiometabolic diseases, and obesity-related cancers. RESULTS:Residing in a neighborhood with a higher BEH-NWI score was associated with a reduced risk of death. Compared to women in the bottom BEH-NWI tertile, those in the highest tertile were 0.96 times (95% CI: 0.93-0.99), 0.91 times (95% CI: 0.86-0.97), and 0.72 times (95% CI: 0.62-0.85) less likely to die from any cause, obesity-related diseases, and in particular, obesity-related cancers, respectively, while adjusting for potential confounders at both the individual and neighborhood level. No association was found between BEH-NWI and risk of death from cardiometabolic diseases. Results were similar in sensitivity analyses censoring women at moving time, and using propensity scores matching women with high and low BEH-NWI on potential confounders. Outdoor walking, average BMI, and/or history of diabetes mediated approximately 5% to 26% of the association between BEH-NWI and mortality. CONCLUSIONS:Our findings suggest a protective role of NW in obesity-related mortality in women, particularly obesity-related cancer mortality. KEYWORDS: walkability, mortality, other (obesity-related mortality), other (women's health)