Association between walkability and diverse health metrics: moderating role of social vulnerability

Little research has considered associations between walkability and multiple health outcomes and the moderating effect of social determinants of health. This study examined relationships between walkability and diverse health issues (depression, poor mental health, poor physical health, mobility disability, obesity) and no leisure-time physical activity and whether these relationships were moderated by social vulnerability. Then, we assessed whether these moderated effects varied between urbanicity. For 1089 census tracts in South Carolina, we compiled EPA National Walkability Index, 6 health metrics from the CDC-PLACES dataset, and the CDC Social Vulnerability Index. Multilevel regression models were employed to account for the nested structure of the data, with census tracts (level 1) nested within counties (level 2). Overall, tract walkability was significantly negatively associated with poor mental health, poor physical health, obesity, and no leisure-time physical activity. The interaction between National Walkability Index and Social Vulnerability Index suggested that the relationship between health metrics and walkability varied depending on the level of social vulnerability in the community. In addition, tract rural or urban classification significantly altered the relationship between walkability and some health metrics. This study's findings provide valuable insights for equitable urban planning and strategies to address walkability and public health issues.