Community-Level Compact City Design, Health Care Provision, and Outcomes of Patients With Stroke

Area of Science:

• Urban planning and public health
• Stroke medicine and epidemiology
• Environmental health and spatial analysis

Background:

• The impact of urbanization scale on stroke healthcare delivery is not fully understood.
• The influence of compact city design on stroke patient outcomes requires further investigation.

Purpose of the Study:

• To assess the association between zip code area-level compact city design, using the walkability index (WI), and stroke outcomes.
• To identify potential mediators in the relationship between compact city design and stroke outcomes.

Main Methods:

• A nationwide retrospective study of stroke patients from the J-ASPECT study (2017-2022).
• Calculation of the walkability index (WI) based on population density, road connectivity, and facility variation across Japanese zip codes.
• Multivariable mixed-effects logistic regression analysis to evaluate the association between WI and in-hospital mortality, functional independence, and medical costs.

Main Results:

• Analysis included 555,296 stroke patients from 818 hospitals.
• Higher WI was significantly associated with reduced in-hospital mortality (OR, 0.94) and increased functional independence (OR, 1.03).
• Decreased mortality was mediated by intensive/stroke care unit management; increased independence was mediated by proximity to hospitals.

Conclusions:

• Compact city design at the zip code level is associated with improved stroke care outcomes, including lower mortality and better functional independence.
• Community-level compact city design can enhance stroke care provision, even without extensive urbanization.
• Findings suggest urban planning strategies can positively impact stroke patient recovery and survival.