Urban sprawl, obesity, and cancer mortality in the United States: Cross-sectional analysis and methodological challenges

David Berrigan, Zaria Tatalovich, Linda Williams Pickle, Reid Ewing, Rachel Ballard-Barbash

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Background: Urban sprawl has the potential to influence cancer mortality via direct and indirect effects on obesity, access to health services, physical activity, transportation choices and other correlates of sprawl and urbanization.Methods: This paper presents a cross-sectional analysis of associations between urban sprawl and cancer mortality in urban and suburban counties of the United States. This ecological analysis was designed to examine whether urban sprawl is associated with total and obesity-related cancer mortality and to what extent these associations differed in different regions of the US. A major focus of our analyses was to adequately account for spatial heterogeneity in mortality. Therefore, we fit a series of regression models, stratified by gender, successively testing for the presence of spatial heterogeneity. Our resulting models included county level variables related to race, smoking, obesity, access to health services, insurance status, socioeconomic position, and broad geographic region as well as a measure of urban sprawl and several interactions. Our most complex models also included random effects to account for any county-level spatial autocorrelation that remained unexplained by these variables.Results: Total cancer mortality rates were higher in less sprawling areas and contrary to our initial hypothesis; this was also true of obesity related cancers in six of seven U.S. regions (census divisions) where there were statistically significant associations between the sprawl index and mortality. We also found significant interactions (p < 0.05) between region and urban sprawl for total and obesity related cancer mortality in both sexes. Thus, the association between urban sprawl and cancer mortality differs in different regions of the US.Conclusions: Despite higher levels of obesity in more sprawling counties in the US, mortality from obesity related cancer was not greater in such counties. Identification of disparities in cancer mortality within and between geographic regions is an ongoing public health challenge and an opportunity for further analytical work identifying potential causes of these disparities. Future analyses of urban sprawl and health outcomes should consider exploring regional and international variation in associations between sprawl and health.

Original languageEnglish (US)
Article number3
JournalInternational Journal of Health Geographics
Volume13
DOIs
StatePublished - Jan 6 2014

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Obesity
Cross-Sectional Studies
Health
Mortality
Neoplasms
Insurance
Public health
Autocorrelation
Health Services
Cross-sectional analysis
Cancer
Urban sprawl
Urban Health
Testing
Urbanization
Spatial Analysis
Insurance Coverage
Censuses
Health Insurance
Public Health

All Science Journal Classification (ASJC) codes

  • Computer Science(all)
  • Business, Management and Accounting(all)
  • Public Health, Environmental and Occupational Health

Cite this

Berrigan, David ; Tatalovich, Zaria ; Pickle, Linda Williams ; Ewing, Reid ; Ballard-Barbash, Rachel. / Urban sprawl, obesity, and cancer mortality in the United States : Cross-sectional analysis and methodological challenges. In: International Journal of Health Geographics. 2014 ; Vol. 13.
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abstract = "Background: Urban sprawl has the potential to influence cancer mortality via direct and indirect effects on obesity, access to health services, physical activity, transportation choices and other correlates of sprawl and urbanization.Methods: This paper presents a cross-sectional analysis of associations between urban sprawl and cancer mortality in urban and suburban counties of the United States. This ecological analysis was designed to examine whether urban sprawl is associated with total and obesity-related cancer mortality and to what extent these associations differed in different regions of the US. A major focus of our analyses was to adequately account for spatial heterogeneity in mortality. Therefore, we fit a series of regression models, stratified by gender, successively testing for the presence of spatial heterogeneity. Our resulting models included county level variables related to race, smoking, obesity, access to health services, insurance status, socioeconomic position, and broad geographic region as well as a measure of urban sprawl and several interactions. Our most complex models also included random effects to account for any county-level spatial autocorrelation that remained unexplained by these variables.Results: Total cancer mortality rates were higher in less sprawling areas and contrary to our initial hypothesis; this was also true of obesity related cancers in six of seven U.S. regions (census divisions) where there were statistically significant associations between the sprawl index and mortality. We also found significant interactions (p < 0.05) between region and urban sprawl for total and obesity related cancer mortality in both sexes. Thus, the association between urban sprawl and cancer mortality differs in different regions of the US.Conclusions: Despite higher levels of obesity in more sprawling counties in the US, mortality from obesity related cancer was not greater in such counties. Identification of disparities in cancer mortality within and between geographic regions is an ongoing public health challenge and an opportunity for further analytical work identifying potential causes of these disparities. Future analyses of urban sprawl and health outcomes should consider exploring regional and international variation in associations between sprawl and health.",
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Urban sprawl, obesity, and cancer mortality in the United States : Cross-sectional analysis and methodological challenges. / Berrigan, David; Tatalovich, Zaria; Pickle, Linda Williams; Ewing, Reid; Ballard-Barbash, Rachel.

In: International Journal of Health Geographics, Vol. 13, 3, 06.01.2014.

Research output: Contribution to journalArticle

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T1 - Urban sprawl, obesity, and cancer mortality in the United States

T2 - Cross-sectional analysis and methodological challenges

AU - Berrigan, David

AU - Tatalovich, Zaria

AU - Pickle, Linda Williams

AU - Ewing, Reid

AU - Ballard-Barbash, Rachel

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N2 - Background: Urban sprawl has the potential to influence cancer mortality via direct and indirect effects on obesity, access to health services, physical activity, transportation choices and other correlates of sprawl and urbanization.Methods: This paper presents a cross-sectional analysis of associations between urban sprawl and cancer mortality in urban and suburban counties of the United States. This ecological analysis was designed to examine whether urban sprawl is associated with total and obesity-related cancer mortality and to what extent these associations differed in different regions of the US. A major focus of our analyses was to adequately account for spatial heterogeneity in mortality. Therefore, we fit a series of regression models, stratified by gender, successively testing for the presence of spatial heterogeneity. Our resulting models included county level variables related to race, smoking, obesity, access to health services, insurance status, socioeconomic position, and broad geographic region as well as a measure of urban sprawl and several interactions. Our most complex models also included random effects to account for any county-level spatial autocorrelation that remained unexplained by these variables.Results: Total cancer mortality rates were higher in less sprawling areas and contrary to our initial hypothesis; this was also true of obesity related cancers in six of seven U.S. regions (census divisions) where there were statistically significant associations between the sprawl index and mortality. We also found significant interactions (p < 0.05) between region and urban sprawl for total and obesity related cancer mortality in both sexes. Thus, the association between urban sprawl and cancer mortality differs in different regions of the US.Conclusions: Despite higher levels of obesity in more sprawling counties in the US, mortality from obesity related cancer was not greater in such counties. Identification of disparities in cancer mortality within and between geographic regions is an ongoing public health challenge and an opportunity for further analytical work identifying potential causes of these disparities. Future analyses of urban sprawl and health outcomes should consider exploring regional and international variation in associations between sprawl and health.

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