Date of Award

Summer 2021

Document Type

Open Access Dissertation

Department

Health Promotion, Education and Behavior

First Advisor

Andrew Kaczynski

Abstract

The purpose of this study was to assess whether neighborhood socioeconomic status (SES), walkability, and green space impacts fall and fracture incidence among postmenopausal women, and to assess important modifiers for these relationships, such as fall history, physical activity, physical impairment, race/ethnicity, and rurality. Data from the Women’s Health Initiative study from 1993 to 2012 (N=161,808) was used.

SES had a significant relationship with falling after adjustment (intermediate vs low SES OR=0.99, p=0.0309; high vs low SES OR=0.99, p=0.1192). Study arm participation and fall frequency at baseline significantly modified this relationship. Walkability had a significant relationship with falling incidence after adjustment (intermediate vs low walkability OR=0.99, p=0.0813; high vs low walkability OR=0.99, p=0.0067) and study arm participation and race/ethnicity significantly modified the relationship. Green space had a significant relationship with falling after adjustment (intermediate vs low green space OR=0.99, p=0.0813; high vs low green space OR=0.99, p=0.0323) and study arm participation significantly modified this relationship.

SES did not have a significant relationship with total fracture after adjustment, although fall frequency at baseline was a significant modifier for this relationship. SES had a significant relationship with hip fracture after adjustment for important covariates (intermediate vs low SES HR=0.98, p=0.5105; high vs low SES HR=0.91, p=0.0052). Study arm participation significantly modified this relationship. Walkability had a significant relationship with total fracture after adjustment (intermediate vs low walkability HR=1.04, p<.0001; high vs low walkability HR=0.98, p=0.0187). Race/ethnicity and rurality significantly modified this relationship. Walkability did not have a significant relationship with hip fracture after adjustment, although study arm participation and physical functioning status modified this relationship. Green space had a significant relationship with total fracture after adjustment (intermediate vs low green space HR=1.08, p<.0001; high vs low green space HR=1.10, p<.0001). Green space did not have a significant relationship with hip fracture after adjustment, although study arm participation modified this relationship.

Results from this longitudinal study showed neighborhood SES, walkability, and green space impact falling and fracture risk. Uncovering relationships between outdoor environments and falling and fracture is important for encouraging independent aging.

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