Active living environments, physical activity and premature cardiometabolic mortality in Canada: a nationwide cohort study.

Mah, Sarah M; Sanmartin, Claudia; Riva, Mylène; Dasgupta, Kaberi; Ross, Nancy A

OBJECTIVE To evaluate sex-specific and age-specific associations of active living environments (ALEs) with premature cardiometabolic mortality. DESIGN Population-based retrospective cohort study. SETTING Residential neighbourhoods (1000-metre circular buffers from the centroids of dissemination areas) across Canada for which the Canadian ALE Measure was derived, based on intersection density, points of interest and dwelling density. PARTICIPANTS 249 420 survey respondents from an individual-level record linkage between the Canadian Community Health Survey (2000-2010) and the Canadian Mortality Database until 2011, comprised of older women (65-85 years), older men (65-81 years), middle-aged women (45-64 years) and middle-aged men (45-64 years). PRIMARY OUTCOME MEASURES Premature cardiometabolic mortality and average daily energy expenditure attributable to walking. Multivariable proportional hazards regression models were adjusted for age, educational attainment, dissemination area-level median income, smoking status, obesity, the presence of chronic conditions, season of survey response and survey cycle. RESULTS Survey respondents contributed a total of 1 451 913 person-years. Greater walking was observed in more favourable ALEs. Walking was associated with lower cardiometabolic death in all groups except for middle-aged men. Favourable ALEs conferred a 22% reduction in death from cardiometabolic causes (HR 0.78, 95% CI 0.63 to 0.97) for older women. CONCLUSIONS On average, people walk more in favourable ALEs, regardless of sex and age. With the exception of middle-aged men, walking is associated with lower premature cardiometabolic death. Older women living in neighbourhoods that favour active living live longer.