City Life May Lower Stroke Risk, Study Suggests | University of Michigan Research
Living in densely developed urban areas may offer unexpected protection against stroke, according to a new University of Michigan study published this week. Researchers found that individuals residing in neighborhoods characterized by a high concentration of buildings, sidewalks and infrastructure experienced a 2.5% reduction in the risk of first-time stroke compared to those in less developed areas.
The decade-long study tracked over 25,000 adults across the United States, utilizing data from REGARDS (REasons for Geographic And Racial Differences in Stroke), a study focused on health disparities within the “stroke belt”—an 11-state region in the Southeastern U.S. Where stroke mortality rates are disproportionately high among Black Americans. Cathy Antonakos, research specialist senior in the U-M School of Kinesiology and the study’s first author, explained the significance of focusing on the stroke belt.
Previous research examining the relationship between neighborhood development and stroke risk has yielded inconsistent results, Antonakos and her colleagues noted. They attributed this inconsistency to reliance on broad urban/rural classifications. To overcome this limitation, the team employed satellite data to measure development intensity over time within 5-mile road networks surrounding over 34,000 residential locations. This approach allowed them to track changes in development and assess its impact on stroke risk.
The association between medium and high-intensity development and reduced stroke risk persisted even after researchers accounted for factors such as age, race, sex, and pre-existing conditions like diabetes and high blood pressure. This suggests that the built environment plays a significant, independent role in stroke incidence.
The study’s findings highlight the potential benefits of urban planning that prioritizes cardiovascular health and physical activity. “High-intensity development typically includes greater housing density and more commercial/retail outlets,” Antonakos said. “These areas are more likely to feature compact land uses with access to health care, food stores, public transport and physical activity infrastructure like sidewalks, bike facilities, and parks.”
While the study did not directly examine these specific environmental features, Antonakos believes the results have practical implications for both medical professionals and urban planners. “For physicians, the study suggests that neighborhood-level factors may influence first-time stroke risk, in addition to individual-level factors,” she stated. “For planners, the findings suggest that enhancing environments with features that support cardiovascular health and physical activity may help lower the risk of first-time stroke.”
The research involved collaboration between the University of Michigan, the University of Alabama at Birmingham, and the University of Cincinnati Academic Health Center. Co-authors include Ian-Marshall Lang, Stephanie Miller and Natalie Colabianch of the University of Michigan; Suzanne Judd of the University of Alabama at Birmingham; and Matthew Flaherty of the University of Cincinnati Academic Health Center.
The study was supported by cooperative agreement U01 NS041588, co-funded by the National Institute of Neurological Disorders and Stroke, National Institute on Aging, National Institutes of Health and Department of Health and Human Services, as well as additional funding from the NINDS and NIA of the NIH under award numbers RF1NS127606 and R01NS127606, and by the NINDS of NIH under award number R01NS092706. Further support was provided through computational resources from the University of Michigan’s Advanced Research Computing division.