Mobility disability and the urban built environment

Abstract

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.

FIGURE 1.

Odds ratios of risk for severe mobility disability by street conditions and lower extremity physical impairment among 1,195 adults aged 45 or more years, Chicago Community Adult Health Study, 2001–2003. “Street conditions” refer to the four streets surrounding the residential block where each respondent lives. Predicted values for the intercept are calculated for an African-American male, aged 70 years or more, with a high school education, never married, living alone, with three underlying chronic health problems, a current smoker, and reporting economic hardship.