Association between adiposity outcomes and residential density: a full-data, cross-sectional analysis of 419 562 UK Biobank adult participants.
Sarkar C., Webster C., Gallacher J.
BACKGROUND: Obesity is a major health issue and an important public health target for urban design. However, the evidence for identifying the optimum residential density in relation to obesity has been far from compelling. We examined the association of obesity with residential density in a large and diverse population sample drawn from the UK Biobank to identify healthy-weight-sustaining density environments. METHODS: For this full-data, cross-sectional analysis, we used UK Biobank data for adult men and women aged 37-73 years from 22 cities across the UK. Baseline examinations were done between 2006 and 2010. Residential unit density was objectively assessed within a 1 km street catchment of a participant's residence. Other activity-influencing built environment factors were measured in terms of density of retail, public transport, and street-level movement density, which were modelled from network analyses of through movement of street links within the defined catchment. We regressed adiposity indicators of body-mass index (BMI; kg/m2), waist circumference (cm), whole body fat (kg), and obesity (WHO criteria of BMI ≥30 kg/m2) on residential density (units per km2), adjusting for activity-influencing built environment factors and individual covariates. We also investigated effect modification by age, sex, employment status, and physical activity. We used a series of linear continuous and logistic regression models and non-linear restricted cubic spline models as appropriate. FINDINGS: Of 502 649 adults in the prospective cohort, 419 562 (83·5%) participants across 22 UK Biobank assessment centres met baseline data requirements and were included in the analytic sample. The fitted restricted cubic spline adiposity-residential density dose-response curve identified a turning point at a residential density of 1800 residential units per km2. Below a residential density of 1800 units per km2, an increment of 1000 units per km2 was positively related with adiposity, being associated with higher BMI (β 0·19 kg/m2, 95% CI 0·14 to 0·24), waist circumference (β 0·41 cm, 0·28 to 0·54), and whole body fat (β 0·40 kg, 0·30 to 0·50), and with increased odds of obesity (odds ratio [OR] 1·10, 1·07 to 1·14). Beyond 1800 units per km2, residential density had a protective effect on adiposity and was associated with lower BMI (β -0·22 kg/m2, -0·25 to -0·20), waist circumference (β -0·54 cm, -0·61 to -0·48), and whole body fat (β -0·38 kg, -0·43 to -0·33), and with decreased odds of obesity (OR 0·91, 0·90 to 0·93). Subgroup analyses identified more pronounced protective effects of residential density among individuals who were younger, female, in employment, and accumulating higher levels of physical activity, except in the case of whole body fat, for which the protective effects were stronger in men. INTERPRETATION: Housing-level policy related to the optimisation of healthy density in cities might be a potential upstream-level public health intervention towards the minimisation and offsetting of obesity; however, further research based on accumulated prospective data is necessary for evidencing specific pathways. The findings might mean that governments, such as the UK Government, who are attempting to prevent suburban densification by, for example, prohibiting the subdivision of single lot housing and the conversion of domestic gardens to housing lots, will potentially have the effect of inhibiting the conversion of suburbs into more healthy places to live. FUNDING: University of Hong Kong, UK Biobank, and UK Economic & Social Research Council.