title: Associations between urban metrics and mortality rates in England.
abstract: BACKGROUND
  Seventy-five percent of the population in Europe live in urban areas and analysing the effects of urban form on the health of the urban population is of great public health interest. Not much is known, however, on the effects of urban form on the health of city dwellers. This study uses a novel approach to investigate whether associations exist between different measures of urban form and mortality risks in cities in England.
  
  
  METHODS
  We conducted an ecological, cross-sectional study for urban areas in England with more than 100,000 residents (n = 50) and included all registered premature deaths (<65 years) between 1(st) January 2002 and 31(st) December 2009. To describe and categorise urban form we quantified the distribution and density of population, land cover and transport networks and measures of geographical characteristics. We used Poisson regression models to examine associations between the measures of urban form and age-standardised risks of deaths from all causes, cardiovascular disease, and traffic accidents after adjustment for socioeconomic status and smoking. Analysis was stratified by gender to explore differential associations between females and males.
  
  
  RESULTS
  There were a total of 200,200 premature deaths during the study period (Females: 37 %; Males: 63 %). Transport network patterns were associated with overall and cardiovascular mortality rates in cities. We saw 12 % higher mortality risk after adjustment in cities with high junction density compared to cities with low density [Females: RR 1.12 (95 % CI 1.10 - 1.15); Males: RR 1.12 (95 % CI 1.10-1.14)]; the risk was slightly higher for cardiovascular mortality [Females: RR 1.16 (95 % CI 1.10 - 1.22); Males: RR 1.12 (95 % CI 1.09 - 1.16)]. Associations between mortality and population patterns were of similar magnitude [Females: RR 1.10 (95 % CI 1.09 - 1.13); Males: RR 1.09 (95 % CI 1.07-1.10)]; associations between mortality and land cover patterns were inconclusive.
  
  
  CONCLUSIONS
  We found an association between transport patterns and risk of premature mortality. Associations between urban form and mortality observed in this study suggest that characteristics of city structure might have negative effects on the overall health of urban communities. Future urban planning and regeneration strategies can benefit from such knowledge to promote a healthy living environment for an increasing urban population.
authors.affiliation: UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Imperial College London, London, W2 1PG, UK. d.fecht@imperial.ac.uk.
authors.forename: Daniela
authors.initials: D
authors.lastname: Fecht
authors.affiliation: UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Imperial College London, London, W2 1PG, UK. l.fortunato@imperial.ac.uk.
authors.forename: Lea
authors.initials: L
authors.lastname: Fortunato
authors.affiliation: UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Imperial College London, London, W2 1PG, UK. d.morley@imperial.ac.uk.
authors.forename: David
authors.initials: D
authors.lastname: Morley
authors.affiliation: UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Imperial College London, London, W2 1PG, UK. a.hansell@imperial.ac.uk.|Imperial College Healthcare NHS Trust, London, W2 1NY, UK. a.hansell@imperial.ac.uk.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Hansell
authors.affiliation: UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Imperial College London, London, W2 1PG, UK. j.gulliver@imperial.ac.uk.
authors.forename: John
authors.initials: J
authors.lastname: Gulliver
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D061213:Mortality, Premature; D016012:Poisson Distribution; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult