Community‐Level Compact City Design, Health Care Provision, and Outcomes of Patients With Stroke
Background The optimal scale of urbanization for stroke health care provision and the potential impact of compact city design on stroke outcomes remain unclear. We investigated the impact of zip code area‐level compact city design using the walkability index (WI) and its mediators on stroke outcomes...
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| Language: | English |
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2025-08-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.125.041293 |
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| author | Yukihiro Imaoka Nice Ren Soshiro Ogata Shogo Watanabe Tomoya Itatani Eri Kiyoshige Hirotoshi Imamura Kunihiro Nishimura Syoji Kobashi Yasuyuki Kaku Koichi Arimura Hitoshi Fukuda Masafumi Ihara Tsuyoshi Ohta Yuji Matsumaru Nobuyuki Sakai Takanari Kitazono Shigeru Fujimoto Kuniaki Ogasawara Koji Yoshimoto Akitake Mukasa Koji Iihara |
| author_facet | Yukihiro Imaoka Nice Ren Soshiro Ogata Shogo Watanabe Tomoya Itatani Eri Kiyoshige Hirotoshi Imamura Kunihiro Nishimura Syoji Kobashi Yasuyuki Kaku Koichi Arimura Hitoshi Fukuda Masafumi Ihara Tsuyoshi Ohta Yuji Matsumaru Nobuyuki Sakai Takanari Kitazono Shigeru Fujimoto Kuniaki Ogasawara Koji Yoshimoto Akitake Mukasa Koji Iihara |
| author_sort | Yukihiro Imaoka |
| collection | DOAJ |
| description | Background The optimal scale of urbanization for stroke health care provision and the potential impact of compact city design on stroke outcomes remain unclear. We investigated the impact of zip code area‐level compact city design using the walkability index (WI) and its mediators on stroke outcomes. Methods This nationwide retrospective study used data from patients with stroke from the J‐ASPECT study (2017–2022). WI was calculated as the average of 3 Z‐scored city design elements (population density, road connectivity, and variation in walkable facilities) from 113 1156 zip code areas in Japan. The association between WI and in‐hospital mortality, functional independence at discharge, and medical costs was assessed using multivariable mixed‐effects logistic regression model. Results Overall, 555 296 patients (median age, 75 [interquartile range, 66–83] years; female, 42.5%) from 818 hospitals were included. Higher WI was significantly associated with decreased in‐hospital mortality (odds ratio [OR], 0.94 [95% CI, 0.92–0.96]) and increased functional independence (OR, 1.03 [95% CI, 1.02–1.04]). The highest WI group was associated with decreased mortality, primarily mediated by management in intensive or stroke care units (proportion mediated, 0.46 [95% CI, 0.35–0.63]), and the highest WI group was associated with increased functional independence, mediated by short road distance to the hospital (proportion mediated, 0.30 [95% CI, 0.21–0.44]). Conclusions Zip code area‐level compact city design was associated with decreased in‐hospital mortality and increased functional independence. Compact city design at community level, even without large‐scale urbanization, may contribute to improving stroke care provision and outcomes in increasingly urbanized societies. |
| format | Article |
| id | doaj-art-858f9bd8500b4c20ad9668d2b8ce40c8 |
| institution | Kabale University |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-858f9bd8500b4c20ad9668d2b8ce40c82025-08-20T03:44:27ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-08-01141510.1161/JAHA.125.041293Community‐Level Compact City Design, Health Care Provision, and Outcomes of Patients With StrokeYukihiro Imaoka0Nice Ren1Soshiro Ogata2Shogo Watanabe3Tomoya Itatani4Eri Kiyoshige5Hirotoshi Imamura6Kunihiro Nishimura7Syoji Kobashi8Yasuyuki Kaku9Koichi Arimura10Hitoshi Fukuda11Masafumi Ihara12Tsuyoshi Ohta13Yuji Matsumaru14Nobuyuki Sakai15Takanari Kitazono16Shigeru Fujimoto17Kuniaki Ogasawara18Koji Yoshimoto19Akitake Mukasa20Koji Iihara21Department of Stroke and Cardiovascular Disease Next Generation Medical Research National Cerebral and Cardiovascular Center Osaka JapanDepartment of Stroke and Cardiovascular Disease Next Generation Medical Research National Cerebral and Cardiovascular Center Osaka JapanDepartment of Preventive Medicine and Epidemiology National Cerebral and Cardiovascular Center Osaka JapanDepartment of Stroke and Cardiovascular Disease Next Generation Medical Research National Cerebral and Cardiovascular Center Osaka JapanDepartment of Fundamental and Community Nursing Science Faculty of Medicine, Miyazaki University Miyazaki JapanDepartment of Preventive Medicine and Epidemiology National Cerebral and Cardiovascular Center Osaka JapanDepartment of Neurosurgery National Cerebral and Cardiovascular Center Osaka JapanDepartment of Preventive Medicine and Epidemiology National Cerebral and Cardiovascular Center Osaka JapanDepartment of Stroke and Cardiovascular Disease Next Generation Medical Research National Cerebral and Cardiovascular Center Osaka JapanDepartment of Neurosurgery Graduate School of Medical Sciences, Kumamoto University Kumamoto JapanDeparment of Neurosurgery Graduate School of Medical Sciences, Kyushu University Fukuoka JapanDepartment of Neurosurgery Kochi Medical School Kochi JapanDepartment of Neurology National Cerebral and Cardiovascular Center Osaka JapanDepartment of Neurosurgery Kobe City Medical Center General Hospital Kyoto Hyogo JapanDepartment of Neurosurgery Institute of Medicine, University of Tsukuba Ibaraki JapanDepartment of Neurosurgery Seijinkai Shimizu Hospital Kyoto JapanDeparment of Medicine and Clinical Science Graduate School of Medical Sciences, Kyushu University Fukuoka JapanDivision of Neurology, Department of Medicine Jichi Medical University Tochigi JapanDeparment of Neurosurgery Iwate Medical University Iwate JapanDeparment of Neurosurgery Graduate School of Medical Sciences, Kyushu University Fukuoka JapanDepartment of Neurosurgery Graduate School of Medical Sciences, Kumamoto University Kumamoto JapanDepartment of Stroke and Cardiovascular Disease Next Generation Medical Research National Cerebral and Cardiovascular Center Osaka JapanBackground The optimal scale of urbanization for stroke health care provision and the potential impact of compact city design on stroke outcomes remain unclear. We investigated the impact of zip code area‐level compact city design using the walkability index (WI) and its mediators on stroke outcomes. Methods This nationwide retrospective study used data from patients with stroke from the J‐ASPECT study (2017–2022). WI was calculated as the average of 3 Z‐scored city design elements (population density, road connectivity, and variation in walkable facilities) from 113 1156 zip code areas in Japan. The association between WI and in‐hospital mortality, functional independence at discharge, and medical costs was assessed using multivariable mixed‐effects logistic regression model. Results Overall, 555 296 patients (median age, 75 [interquartile range, 66–83] years; female, 42.5%) from 818 hospitals were included. Higher WI was significantly associated with decreased in‐hospital mortality (odds ratio [OR], 0.94 [95% CI, 0.92–0.96]) and increased functional independence (OR, 1.03 [95% CI, 1.02–1.04]). The highest WI group was associated with decreased mortality, primarily mediated by management in intensive or stroke care units (proportion mediated, 0.46 [95% CI, 0.35–0.63]), and the highest WI group was associated with increased functional independence, mediated by short road distance to the hospital (proportion mediated, 0.30 [95% CI, 0.21–0.44]). Conclusions Zip code area‐level compact city design was associated with decreased in‐hospital mortality and increased functional independence. Compact city design at community level, even without large‐scale urbanization, may contribute to improving stroke care provision and outcomes in increasingly urbanized societies.https://www.ahajournals.org/doi/10.1161/JAHA.125.041293city designcity environmentcompact cityprimary stroke centerstrokeurban |
| spellingShingle | Yukihiro Imaoka Nice Ren Soshiro Ogata Shogo Watanabe Tomoya Itatani Eri Kiyoshige Hirotoshi Imamura Kunihiro Nishimura Syoji Kobashi Yasuyuki Kaku Koichi Arimura Hitoshi Fukuda Masafumi Ihara Tsuyoshi Ohta Yuji Matsumaru Nobuyuki Sakai Takanari Kitazono Shigeru Fujimoto Kuniaki Ogasawara Koji Yoshimoto Akitake Mukasa Koji Iihara Community‐Level Compact City Design, Health Care Provision, and Outcomes of Patients With Stroke Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease city design city environment compact city primary stroke center stroke urban |
| title | Community‐Level Compact City Design, Health Care Provision, and Outcomes of Patients With Stroke |
| title_full | Community‐Level Compact City Design, Health Care Provision, and Outcomes of Patients With Stroke |
| title_fullStr | Community‐Level Compact City Design, Health Care Provision, and Outcomes of Patients With Stroke |
| title_full_unstemmed | Community‐Level Compact City Design, Health Care Provision, and Outcomes of Patients With Stroke |
| title_short | Community‐Level Compact City Design, Health Care Provision, and Outcomes of Patients With Stroke |
| title_sort | community level compact city design health care provision and outcomes of patients with stroke |
| topic | city design city environment compact city primary stroke center stroke urban |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.125.041293 |
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