Why where you live affects your risk of premature death

Feeling safe from crime has been linked to a 9 per cent lower risk of premature death and 6 per cent lower likelihood of a heart attack, according to a study of more than 35,000 adults.

“There is increasing evidence that the neighbourhood we live in affects our health,” said study author Dr Mengya Li of the National Centre for Cardiovascular Diseases in Beijing, China.

“This study highlights the importance of many aspects of our surroundings for heart health and longevity, including feeling safe, having shops, transport and parks close by, cleanliness and feeling that our neighbourhood is a good place to live and to raise children.”

The researchers used data from the Pure-China study to investigate the association between neighbourhood characteristics, cardiovascular disease (CVD) and death.

The study included 35,730 adults aged 35 to 70 years from 115 communities – 70 urban and 45 rural – in 12 provinces of China, between 2005 and 2009.

The average age of participants was 51 years and 60 per cent were women.

Trained research staff conducted interviews to collect baseline information on the neighbourhood environment using the Neighbourhood Environment Walkability Scale (News).

The questionnaire contained eight subscales:

• How long it takes to walk to shops, restaurants, banks, pharmacies, work, transport stops and parks;
• Perceived ease of walking to shops and transport stops;
• The distance between intersections, which indicates ease of getting around;
• Infrastructure for walking or cycling;
• Aesthetics, such as trees shading the pavement, interesting things to look at while walking and no litter;
• Safety from traffic (e.g. the amount of traffic and safety crossing the street;
• Safety from crime, including street lighting at night, crime rate and safety walking during the day and night;
• Community satisfaction, such as with public transport, commute to work, access to shopping, and whether the area is a good place to live and to raise children.

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The researchers followed up for all-cause death, death due to CVD, major CVD events (defined as death from cardiovascular causes, non-fatal myocardial infarction, stroke or heart failure).

They analysed the associations between each subscale and the total score and health outcomes after adjusting for factors that could influence the results.

During a median follow-up of 11.7 years, there were 2,034 (5.7 per cent) all-cause deaths, of which 765 were attributed to CVD, and 3,042 (8.5 per cent) major CVD events.

A higher neighbourhood environment score was associated with a 6 per cent lower risk of the primary outcome of major CVD events and all-cause mortality, a 12 per cent lower likelihood of death during follow-up, and a 10 per cent reduced risk of death due to CVD.

A higher neighbourhood safety score was associated with a 9 per cent lower risk of death during follow-up, 10 per cent lower risk of death from CVD, 3 per cent reduced likelihood of major CVDs, 6 per cent reduced risk of myocardial infarction and 10 per cent lower likelihood of heart failure.

“While some of the percentage reductions in risk are small, they affect large numbers of people and therefore could have a wide-ranging impact," Dr Li said.

"The findings can be used by policymakers to take action to mitigate the adverse effect of poor community conditions on health, such as improving local amenities and transport connectivity, providing green spaces and street lighting, and building paths for walking, running and cycling.”