Background
Seventy-five percent of the population in Europe live in urban areas and analysing the effects
of urban form on the health of the urban population is of great public health interest. Not
much is known, however, on the effects of urban form on the health of city dwellers. This
study uses a novel approach to investigate whether associations exist between different
measures of urban form and mortality risks in cities in England.
Methods
We conducted an ecological, cross-sectional study for urban areas in England with more than
100,000 residents (n = 50) and included all registered premature deaths (<65 years) between
1
st January 2002 and 31th December 2009. To describe and categorise urban form we
quantified the distribution and density of population, land cover and transport networks and
measures of geographical characteristics. We used Poisson regression models to examine
associations between the measures of urban form and age-standardised risks of deaths from
all causes, cardiovascular disease, and traffic accidents after adjustment for socioeconomic
status and smoking. Analysis was stratified by gender to explore differential associations
between females and males.
Results
There were a total of 200,200 premature deaths during the study period (Females: 37%;
Males: 63%). Transport network patterns were associated with overall and cardiovascular
mortality rates in cities. We saw 12% higher mortality risk after adjustment in cities with high
junction density compared to cities with low density [Females: RR 1.12 (95% CI 1.10 –
1.15); Males: RR 1.12 (95% CI 1.10 -1.14)]; the risk was slightly higher for cardiovascular
mortality [Females: RR 1.16 (95% CI 1.10 – 1.22); Males: RR 1.12 (95% CI 1.09 – 1.16)].
Associations between mortality and population patterns were of similar magnitude [Females:
3
RR 1.10 (95% CI 1.09 – 1.13); Males: RR 1.09 (95% CI 1.07 -1.10)]; associations between
mortality and land cover patterns were inconclusive.
Conclusions
We found an association between transport patterns and risk of premature mortality.
Associations between urban form and mortality observed in this study suggest that
characteristics of city structure might have negative effects on the overall health of urban
communities. Future urban planning and regeneration strategies can benefit from such
knowledge to promote a healthy living environment for an increasing urban population.