Pavements to Longevity: The Influence of Neighborhood Walkability on Mortality in Taiwan

Background: There is limited information on the association between walkability and health in Asian countries.
Objective: Our study aimed to investigate the association between neighborhood walkability and mortality in Taiwanese adults.
Methods: We selected 457,874 participants (≥18 y of age) from Taiwan who joined a standard medical examination program between 1998 and 2016 and followed them until 31 July 2021. Three walkability measures were estimated within a walking distance of 640m of participant’s addresses: points of interest (POI), transit stations, and impedance (restrictions to walking due to absence of intersections and physical barriers). Walkability measures were applied as continuous and categorical (tertiles) variables in data analyses. Mortality data were obtained from the National Death Registry maintained by the Ministry of Health and Welfare in Taiwan. A time-varying Cox regression model was used to investigate the association of neighborhood walkability with deaths from natural causes and specific causes.
Results: This study identified 24,744 deaths over a median follow-up of 16.9 y. In comparison with participants living with the first tertile for numbers of POI and transit stations, those living with higher numbers of POI and transit stations were associated with a lower risk of natural-cause mortality, with hazard ratios (HRs) of 0.97 [95% confidence intervals (CIs): 0.94, 1.00] and 0.93 (95% CI: 0.90, 0.96) for second and third tertiles of numbers of POI, and 0.99 (95% CI: 0.96, 1.02) and 0.94 (95% CI: 0.92, 0.98) for second and third tertiles of numbers of transit stations, respectively. Each unit increase in POI and transit stations was associated with a 3% (HR= 0.97; 95% CI: 0.96, 0.99) and 2% (HR= 0.98; 95% CI: 0.97, 0.99) reduced risk of natural-cause mortality, respectively. In addition, in comparison with living in areas with the first tertile of impedance, living with the third tertile of impedance was associated a higher risk of natural-cause mortality, with HRs of 1.01 (95% CI: 1.00, 1.03). One unit increase in impedance was associated with a 1% (HR= 1.01; 95% CI: 1.00, 1.03) increased risk of natural-cause mortality. We also found significantly inverse associations between three walkability measures with deaths from cardiovascular diseases and between POI and death from chronic respiratory diseases.
Conclusion: Our findings indicate that a higher level of neighborhood walkability was associated with a lower risk of mortality. Our data suggest that it is important to take into account neighborhood walkability in urban planning and health guideline development.