Association Between Active Living Environments and Hospitalization for All-Causes and Cardiometabolic Disease

Abstract

Introduction Neighbourhoods have the potential to influence population-wide modifiable risk factors such as physical inactivity and obesity. Built environments that encourage active living hold promise as a policy lever for reducing health care burden, particularly that related to cardiometabolic disease. Objectives and Approach We examined the role of active living environments on hospitalization risk, frequency, and cumulative length of stay for all-causes and cardiometabolic diseases. The linked dataset is a combination of survey data from Canadian respondents aged 45+, records from a national census of acute hospitalizations, and the Canadian Active Living Environment (Can-ALE) - a 5-class measure of how conducive one’s neighbourhood is to active living based on street connectivity, points of interest, and population density. We modelled the risk of all-cause and cardiometabolic hospitalizations for respondents living in more and less favourable environments using logistic regression. Frequency and cumulative length of stay were modelled using truncated negative binomial regression. Models were adjusted for individual-level factors and proximity to a hospital. An offset variable was included to account for different follow-up times. Results 232,000 respondents were included with a mean follow-up time of 5.37 years. Those living in progressively more favourable active living environments (classes 2, 3, 4, and 5) exhibited incrementally lower risk of hospitalization compared to those living in the least favourable (class 1). Relative to respondents living in the least favourable environments (class 1), odds ratios were 0.84 (95% CI 0.76-0.93) for all-cause hospitalization and 0.80 (95% CI 0.68-0.93) for cardiometabolic hospitalization for respondents living in the most favourable environments (class 5). There was little evidence of similar associations for hospitalization frequency and cumulative length of stay. Conclusion / Implications Living in neighbourhoods that are more conducive to active living are associated with lower risk of all-cause and cardiometabolic hospitalization.