The Association between Urban Form and Ischemic Heart Disease: Evidence from Brisbane, Australia

Review Article

Austin J Public Health Epidemiol. 2015;2(1): 1014.

The Association between Urban Form and Ischemic Heart Disease: Evidence from Brisbane, Australia

Gudes O1,2*, Ball SJ3, Dur F4, Burke M5 and Varhol R6

1Department of Spatial Sciences, Curtin University, Australia

2Centre for Community Science, Griffith University, Australia

3Telethon Kids Institute, University of Western Australia, Australia

4Environment and Sustainability Branch, Logan City Council, Australia

5Urban Research Program, Griffith University, Australia

6Department of Health Policy & Management and Health Information Management, Curtin University, Australia

*Corresponding author: Gudes O, Department of Spatial Sciences, Curtin University and Centre for Community Science, Griffith Health Institute, Griffith University, Australia

Received: January 13, 2015; Accepted: March 28, 2015; Published: March 31, 2015


We measured the association between urban form and hospitalisation rates for Ischaemic Heart Disease (IHD), stratified by age and sex, and controlling for ethnicity, socioeconomic status, proximity to hospital and neighbourhood walkability. This was a retrospective cohort study of the proportion of people within the Brisbane area of Australia, which were hospitalised between 2006 to 2011 with a primary diagnosis of IHD. There were strong spatial patterns in the incidence of IHD. The importance of predictor variables differed by sex and age. Urban form was generally not a strong predictor. This study suggests no strong relationship was identified between urban form factors and ischemic heart disease using this research approach.

Keywords: Ischaemic heart disease; Urban form and structure; Spatial analysis


Ischaemic Heart Disease (IHD) is characterised by reduced blood supply to the heart. It is one of the most common causes of mortality world-wide, resulting in 11.2% of deaths globally in 2011 [1]. In Australia, IHD accounts for 16% of all deaths [2], placing it 9th internationally in terms of contribution to national burden of disease. Major risk factors of this disease include family history of coronary artery disease, diabetes, high blood pressure or atherosclerosis, smoking, poor nutrition (especially dietary fat intake), previous heart attack or stroke, obesity, hypertension, elevated cholesterol and/or low level of High Density Lipoprotein (HDL) [3].

The built environment is highlighted as a factor determining health outcomes, as part of a broader social determinants model of health [4], yet very little is known about the effects of urban form on IHD. It has recently been proposed that urban form (the physical shape and structure of a city that influences daily activity)is an important behavioural determinant [5]. Previous studies have related urban form to travel behaviour, walking and other forms of physical activity [6,7], air pollution [8] and obesity [9,10]. These effects may be of some significance for IHD. The aim of this study paper is to test for an association between urban form and the incidence of IHD in Brisbane, Australia’s third largest city. We also control for the effects of age, sex, ethnicity, socioeconomic status, proximity to hospital and neighbourhood walkability.

Methodological approach, design and settings

This study was a retrospective cohort study of spatial variation in the incidence of hospitalisations due to IHD in southern metropolitan Brisbane, Australia (Figure 1) from 1 January 2006 to 31 December 2011. Brisbane is the third largest city in Australia, with a population of 2.07 million in 2011 [11]. The spatial units were Statistical Local Areas (SLAs), as defined by the Australian Bureau of Statistics [11]. Here after the term �study area� refers to the 118 SLAs used for analysis (Figure 2).