Neighborhood walkability and subsequent health and well-being in urban and rural Japan: An outcome-wide longitudinal study

Background

Walkability notably affects the health of older adults; however, its relationship with various outcomes in different geographical contexts remains unclear. Considering urban–rural differences, this study examined associations between neighborhood walkability and the health and well-being of older adults in Japan.

Methods

Data were obtained from the Japan Gerontological Evaluation Study, a nationwide cohort study of Japanese adults aged ≥65 years, across three waves (2013, 2016, and 2019). This study included 27,354 participants in the survey-based sample and 40,111 participants in the long-term care insurance-based sample. Neighborhood walkability was assessed using a composite index derived from population density, distance to retail and park areas, and road density. Forty-two outcomes across seven domains were analyzed using multilevel regression models stratified by urbanicity. Bonferroni correction was applied (α = 0.0012).

Results

In urban settings, higher walkability was significantly associated with increased walking time. Conversely, in rural areas, higher walkability showed mixed results; it was significantly associated with increased participation in hobby/sports groups and outings, but also with increased risk of functional disability (level ≥2), increased sedentary behavior, and decreased norms of reciprocity. Walkability was not significantly associated with walking time.

Conclusions

Walkability can have different effects on health and well-being in urban and rural areas, highlighting the need for location-specific strategies. While urban efforts could focus on pedestrian infrastructure, effective rural strategies would likely involve an integrated approach that addresses transportation, social connectivity, and activity promotion.