Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #117021

Chantal M. Montagnet, MA, MPhil¹, Mary Putt, PhD, ScD¹, and Katrina Armstrong, MD². (1) School of Medicine, University of Pennsylvania, 423 Guardian Drive, 1129 Blockley Hall, Philadelphia, PA 19104-6021, 215.898.0162, cmontagn@mail.med.upenn.edu, (2) Internal Medicine, University of Pennsylvania, 1233 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104

Place matters in health: Pervasive health inequalities are found for gender, race/ethnicity, social class, and geography. Urban areas are geographies of contradictions where sharp physical and socioeconomic juxtapositions translate into health inequalities. The Big Cities Health Inventory (BCHI) showed that health outcomes for the largest US cities were generally worse than smaller cities, rural areas, and the nation as a whole. BCHI also found worse health outcomes for Blacks than Whites. By expanding the findings from BCHI to incorporate contextual data on the urban environment — sprawl and segregation, we discovered an association between increased sprawl, segregation, and higher death rates. We explored the relationship between all-cause and specific mortality rates, city-level segregation, and MSA-level sprawl for 43 cities. BCHI data were merged with city-level segregation data (index of dissimilarity) from the Racial Residential Segregation Measurement Project and MSA-level sprawl data from Smart Growth America. Total sprawl is an index comprised of four factors: Residential density; neighborhood mix (residential-commercial); city centeredness; and street connectivity. Sprawl was significantly correlated with the following mortality rates in unadjusted analyses: overall (r=-.365, p=.016), heart disease(r=-.323, p=.034), and infant (r=-.330, p=.030). These associations were attenuated by adjustment for US region, city population, and segregation, but remained of potential public health significance. For example, after adjustment, a 50 point decrease in sprawl was associated with a decrease in the overall mortality rate of 124.8 deaths per 100,000 (p=0.07) and a decrease in the infant mortality rate of 1.9 deaths per 1000 live births (p=0.09).

Learning Objectives: After viewing this poster, the audience will be able to

• Identify health indicators that are correlated with sprawl and segregation in large US cities
• Define the dissimilarity index
• Explain the sprawl index

Keywords: Mortality, Urban Health

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.