December 16, 2020

NEW PAPER ON ACTIVE LIVING ENVIRONMENTS AND PREMATURE CARDIOMETABOLIC MORTALITY PUBLISHED BY SARAH M MAH

Congratulations to research group member Sarah Mah and co-authors Dr. Claudia Sanmartin, Dr. Mylène Riva, Dr. Kaberi Dasgupta, and Dr. Nancy A. Ross on their recent publication in BMJ Open. The article, Active living environments, physical activity and premature cardiometabolic mortality in Canada: a nationwide cohort study, looks at and uncovers important relationships between active living environments (ALEs), physical activity, and premature cardiometabolic mortality.

We used linked administrative data from nearly 250,000 respondents of the Canadian Community Health Survey and death records in the Canadian Mortality Database to conduct a population-based retrospective cohort study. This rich linked dataset contains information on social and demographic characteristics as well as the health behaviours of the cohort – including leisure-time physical activity and walking. We then linked these individuals’ neighbourhoods with the Canadian Active Living Environments (Can-ALE) database to see whether living in communities that are more conducive for active living is related to physical activity, walking, and premature cardiometabolic death.

Figure 1. Authors examined associations between active living environments, physical activity, and premature cardiometabolic death. The cohort was stratified by sex as well as age group (older, middle age). To assess premature deaths, different follow-up times were used to account for differences in life expectancy between women (life expectancy ~85 years) and men (~81 years) in Canada.

Results indicate that, on average, people tend to walk more in neighbourhoods with favourable conditions, and that more walking is associated with lower premature cardiometabolic death (with the exception of middle-aged men in this study).

Figure 2. Average daily energy expenditure related to walking. Data are mean or (%). Active living environment (ALE) 1 represents the least favourable environment, while ALE 5 represents the most favourable environment. Boxes represent the IQR (25th–75th percentile) and the horizontal line represents the median. Note that upper and lower limits of the boxplots have been adjusted to represent the 90th and 10th percentile, respectively, for confidentiality purposes. Red markers and trend line represent means in each ALE class with test for trend (P<0.05).

Survival analysis showed that more favourable ALEs were associated with a 22% reduction in premature cardiometabolic-related death rates in older women.

Figure 3. Association of the active living environment with premature cardiometabolic mortality. Data are HRs (95% CI). Unadjusted models (dashed) are adjusted for age. Adjusted models (solid) are adjusted for age, education, income, the presence of two or more chronic conditions, obesity, and survey cycle.

These conclusions underscore the importance of the built environment in shaping both behaviour and downstream health. Urban planning that prioritizes quality active living environments may be an effective way to encourage physical activity and reduce premature cardiometabolic death. Our study indicates that decision-makers seeking to improve health outcomes in their communities should consider supporting interventions aimed at making neighborhoods more conducive to active living.

Photo credit: ©Jean-Michael Seminaro