HMN 2026: How Urban living may shield against stroke, longitudinal

While urban life is often associated with stress and pollution, living in more intensely developed neighborhoods may actually protect against stroke, a new University of Michigan study suggests. The research published in Cities & Health tracked more than 25,000 adults across the United States for over a decade, and found that residents in areas with higher levels of development, characterized by more buildings, sidewalks and infrastructure, had a 2.5% lower risk of suffering a first-time stroke compared to residents in less developed areas.

The study utilized data from REGARDS, the REasons for Geographic And Racial Differences in Stroke study, which addresses health disparities in the “stroke belt,” an 11-state region in the Southeastern U.S. where stroke mortality is disproportionately high among Black Americans, said Cathy Antonakos, research specialist senior in the U-M School of Kinesiology and first author.

Past research on how neighborhood development impacts stroke risk has been inconsistent, perhaps because it relied on static urban/rural labels, she said.

To address this, Antonakos and colleagues moved away from one-time snapshots and instead used satellite data to measure development intensity over time in 5-mile (8-km) road networks surrounding more than 34,000 residential locations. They found that the link between high/medium intensity development and reduced stroke risk remained—even after accounting for age, race, sex and preexisting conditions like diabetes and high blood pressure.

The next step in the research is to identify specific environmental features that are more common in areas with greater development intensity as compared to less developed areas, Antonakos said.

“High-intensity development typically includes greater housing density and more commercial/retail outlets,” she said. “These areas are more likely to feature compact land uses with access to health care, food stores, public transport and physical activity infrastructure like sidewalks, bike facilities and parks.”

The study did not examine these environmental features, but there are some practical applications, Antonakos said.

“For physicians, the study suggests that neighborhood-level factors may influence first-time stroke risk, in addition to individual-level factors,” she said. “For planners, the findings suggest that enhancing environments with features that support cardiovascular health and physical activity may help lower the risk of first-time stroke.”

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