American Journal of Epidemiology Advance Access originally published online on July 30, 2008
American Journal of Epidemiology 2008 168(5):506-513; doi:10.1093/aje/kwn185
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ORIGINAL CONTRIBUTIONS |
Mobility Disability and the Urban Built Environment
1 Institute for Social Research, University of Michigan, Ann Arbor, MI
2 Department of Sociology, University of Michigan, Ann Arbor, MI
Correspondence to Dr. Philippa Clarke, Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI 48106-1248 (e-mail: pjclarke{at}umich.edu).
Received for publication November 2, 2007. Accepted for publication May 28, 2008.
Research on the effects of the built environment in the pathway from impairment to disability has been largely absent. Using data from the Chicago Community Adult Health Study (2001–2003), the authors examined the effect of built environment characteristics on mobility disability among adults aged 45 or more years (n = 1,195) according to their level of lower extremity physical impairment. Built environment characteristics were assessed by using systematic social observation to independently rate street and sidewalk quality in the block surrounding each respondent's residence in the city of Chicago (Illinois). Using multinomial logistic regression, the authors found that street conditions had no effect on outdoor mobility among adults with only mild or no physical impairment. However, among adults with more severe impairment in neuromuscular and movement-related functions, the difference in the odd ratios for reporting severe mobility disability was over four times greater when at least one street was in fair or poor condition (characterized by cracks, potholes, or broken curbs). When all streets were in good condition, the odds of reporting mobility disability were attenuated in those with lower extremity impairment. If street quality could be improved, even somewhat, for those adults at greatest risk for disability in outdoor mobility, the disablement process could be slowed or even reversed.
aging; lower extremity; mobility limitation; social environment; urban health
Abbreviations: GIS, geographic information systems; ICF, International Classification of Functioning, Disability, and Health; SSO, systematic social observation