Deciphering the stroke–built environment nexus in transitional cities: Conceptual framework, empirical evidence, and implications for proactive planning intervention

Abstract

Adverse lifestyle-associated health outcomes, and stroke in particular, have been aggravated in transitional countries under high-speed urbanisation. Against this backdrop, deciphering the nexus between built environments (BEs) and lifestyleassociated health outcomes is of importance for crafting proactive interventions. The existing literature on this topic, however, fails to sufficiently capture the multiplicity of health-related BEs and, in turn, the complexity of such a nexus, largely challenging the applicability of established frameworks and the reliability of relevant findings.Looking at the case of stroke in Wuhan, China, this research aims to flesh out the understanding of the nexus between multidimensional BEs and lifestyle-associated health outcomes in transitional cities, with regards to conceptual framework and empirical evidence. To this end, we clarified stroke-related BE elements and integrated them into one conceptual framework. We then visualised stroke risk and examined its BE determinants using the Bayesian conditional autoregressive model.The visualisation results showed that stroke risks exhibited significant clustering in the high-density urban core. The statistical analysis found that, after the data were controlled for sociodemographic characteristics, net population density and building density were positively associated with stroke risk. In contrast, an abundance of public parks and institutional land use and access to medical care facilities have presented negative correlations with stroke risk, regardless of urban density. Our research reveals that compact urban developments might not be a silver bullet for health promotion in transitional cities, calling for an urgent need to scrutinise their applicability. Moreover, providing better access to these identified salubrious resources is crucial for offsetting the adverse effects of increasingly dense urban environments. Furthermore, we argue that the establishment of comprehensive conceptual frameworks that connect BEs and lifestyle-associated health outcomes deserves to be highlighted in further research, planning intervention schemes, and health impact assessment projects.

Quality of urban parks in the perception of city residents with mobility difficulties

“…Proximity to green spaces and high visit frequency is associated with a perceived mental well-being improvement and better physical health condition ( Romagosa, 2018 ; Houlden et al, 2019 ; Liu et al, 2019 ; Martin et al, 2020 ). People who are deprived of contact with nature or have difficult access to green areas are more at risk of depression and decreased functional ability, which in turn can lead to a significant deterioration in the quality of their life ( Whyte, 2001 ; Xie et al, 2019 ). That is why it seems essential for green areas in the urban agglomeration to be safe, available, and accessible to everyone, as for many people spending time in the park is the only possibility of close contact with nature in everyday life.…”

Going Green and Going Dense: A Systematic Review of Compatibilities and Conflicts in Urban Research

“…For instance, two large-scale studies in multiple European and Chinese cities evaluated the association between urban form elements such as land covers and mortality ratios, finding that dense urban environments with a lack of green land covers were associated with a higher mortality [75,76]. Additionally, a study conducted by Xie, et al [77] in Wuhan, China, found that population density and building density were positively associated with stroke risk and, in contrast, a negative correlation between abundance of public parks and stroke risk, regardless of urban density. Similarly, Cusack, et al [78] observed positive associations between mothers' exposure to green space and term birth weight, especially in high-density locations in Vancouver and Toronto, Canada.…”

Quantifying the Impact of Acute Stroke System of Care Transfer Protocols on Patient Outcomes

“…In demand generation, patient location is stratified solely by population density, despite a significant impact of aging, smoking, and hypertension. The assumption stems from a statistical analysis by Xie et al (2019), 59 which shows that net population density and building density are positively associated with stroke risk. Because of the timedependent nature of stroke treatment, stroke patients are highpriority patients; therefore, there are no waiting times associated with EMS or hospitals.…”