Poor neighbourhood walkability associated with increased fracture risk

1. In this longitudinal cohort study, neighborhood walkability and greenness were associated with decreased fracture risk. 

Evidence rating level: 2 (Good)

Neighborhood walkability and greenness are associated with health benefits, namely by promoting greater levels of physical activity, reducing exposure to pollution, increasing social connections, and reducing psychological stress. This longitudinal study aimed to examine whether walkability and greenness are associated with fracture risk. 23,940 participants were recruited for this cohort study in Ningbo, China between June 2015 and January 2018. Participant observation continued until February 2023. Mean (SD) age was 63.4 (9.4) years. During the follow-up of 134,638 person-years, 3322 incident fractures occurred. A decrease in fracture risk was associated with every interquartile range (IQR) increment in neighborhood walkability and greenness, with a hazard ratio of 0.88 (95% CI, 0.83-0.92) and 0.84 (95% CI, 0.80-0.89) respectively. Furthermore, for neighborhoods in the highest quartile for walkability, greenness reduced fracture risk with a hazard ratio of 0.62 (95% CI, 0.46-0.82). This cohort study demonstrates that exposure to neighborhood walkability and residential greenness are both associated with decreased fracture risk. A limitation of this study is that the authors did not control for confounding variables other than air pollution. This is important to consider because having a residential address in a walkable neighborhood with more greenspaces may be associated with higher socioeconomic status, which was not accounted for in the current study. Other potential confounders such as smoking, alcohol consumption, and BMI were also not adjusted for. Overall, this study adds to the growing literature suggesting that neighborhood walkability and greenness are important determinants of health. 

Click to read the study in JAMA Network Open

Image: PD

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