Relationships of the built environment (BE) with physical activity (PA) and health outcomes have been reported, though data is limited in rural settings. This study was conducted to assess relationships between BE around the residence and death from chronic disease in rural residents. We hypothesized that BE more conducive to PA would be associated with lower odds of chronic disease death. Participants in the Bogalusa Heart Study, a long-running cohort study in rural Louisiana, with a valid address of residence and either deceased of a chronic disease (cases) or observed (controls) since 1998 were included (N=2,052). Cases were identified in the National Death Index (N=111). BE features on the street segment of residence were assessed with the Rural Active Living Assessment tool and Google Street View. Scores for walkability, overall and in domains (including path features, aesthetics, land use), were calculated for street segments and in buffers of 0.25, 0.50, 1.00 and 1.50 miles. Associations of BE scores with chronic disease death were assessed with generalized estimating equations logistic regression models that accommodated clustering in street segments and census tracts, and were adjusted for age, sex, race, census tract population density and percent living in poverty. Cases were of similar age (45 at death vs 44 at last visit), more likely to be male (59 vs 43%) and less likely to be white (52 vs 66%) than controls. Significant associations were observed between scores for path features, aesthetics and land use and odds of chronic disease death in buffers of 0.25, 0.50, 1.00 and 1.50 miles. In 0.25 mile buffers, 1-point higher scores for path features, aesthetics and land use were associated with 1.12 (95% CI 1.02, 1.23), 0.66 (95% CI 0.53, 0.82) and 0.49 (95% CI 0.32,0.76) times the odds of chronic disease death, respectively. Significant associations highlight the importance of land use development conducive to PA (i.e. higher density and better condition residential settlement) and improved community aesthetics (i.e. greenspace presence and maintenance) to improved health in rural populations. More research is needed to identify a mechanism for the unexpected association between path features (i.e. presence of a path) and increased odds of chronic disease death. Rural BE improvements face barriers (lower population density), and these reported associations may guide feasible approaches to improved rural health.
Eye-Level Street Greenery and Walking Behaviors of Older Adults
