• Byoungjun Kim, Ben R Spoer, Andrea R Titus, Alexander Chen, George D Thurston, Marc N Gourevitch, and Lorna E Thorpe.
• Department of Population Health, New York University Grossman School of Medicine, New York, New York. Electronic address: byoungjun.kim@nyulangone.org.
• Am J Prev Med. 2023 Apr 1; 64 (4): 468476468-476.

IntroductionThe purpose of this study is to examine the associations between built environments and life expectancy across a gradient of urbanicity in the U.S.MethodsCensus tract‒level estimates of life expectancy between 2010 and 2015, except for Maine and Wisconsin, from the U.S. Small-Area Life Expectancy Estimates Project were analyzed in 2022. Tract-level measures of the built environment included: food, alcohol, and tobacco outlets; walkability; park and green space; housing characteristics; and air pollution. Multilevel linear models for each of the 4 urbanicity types were fitted to evaluate the associations, adjusting for population and social characteristics.ResultsOld housing (built before 1979) and air pollution were important built environment predictors of life expectancy disparities across all gradients of urbanicity. Convenience stores were negatively associated with life expectancy in all urbanicity types. Healthy food options were a positive predictor of life expectancy only in high-density urban areas. Park accessibility was associated with increased life expectancy in all areas, except rural areas. Green space in neighborhoods was positively associated with life expectancy in urban areas but showed an opposite association in rural areas.ConclusionsAfter adjusting for key social characteristics, several built environment characteristics were salient risk factors for decreased life expectancy in the U.S., with some measures showing differential effects by urbanicity. Planning and policy efforts should be tailored to local contexts.Copyright © 2022 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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