Study Finds Association Between Childhood Asthma and Low Neighborhood Walkability

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Children who live in neighborhoods with low walkability may be more likely to develop asthma that will continue through later childhood.

Research in the past has suggested that certain variables of childhood asthma are associated with physical activity. According to a study, children who live in neighborhoods with low walkability may be more likely to develop asthma that will continue through later childhood.

The study used administrative healthcare data for the Province of Ontario from the Institute for Clinical Evaluative Sciences. The researchers measured the home neighborhood walkability quintile with a walkability index that included four dimensions—population density, dwelling density, access to retail and services, and street connectivity.

“We found that children living in neighborhoods with low walkability were more likely to develop asthma and to continue to have asthma during later childhood,” said author Elinor Simons, MD, PhD, a pediatric allergist and clinician scientist. “These findings show a relationship between lack of day-to-day physical activity or sedentary lifestyle and development of new and ongoing asthma in Toronto children.”


Incident asthma was defined in the study by the time of entry into the validated Ontario Asthma Surveillance Information System database, which requires two outpatient visits for asthma within two consecutive years or any hospitalization for asthma. Using the incidence of asthma, the researchers were able to identify associations with walkability and examined the connection using Cox proportional hazards models.

The results revealed that 21% of children developed incident asthma and were then followed longitudinally in the Ontario Asthma Surveillance Information System database. Also, low birth home neighborhood walkability was associated with an increased incidence of asthma. Low walkability in a given year of a child’s life was found to be associated with increased odds of ongoing asthma in the same year.

“Toronto has a population of over 6 million multiethnic inhabitants, making it representative of many large urban centers in industrialized countries,” said the authors of the study. “Other large cities may have neighborhood walkability patterns that are similar to Toronto’s, and may see similar associations with childhood asthma.”

The study also emphasized that neighborhood walkability improvement, such as adding pedestrian paths to improve street connectivity, may act as potential strategies to contribute primary asthma prevention going forward.

“It is important to note that this study measured physical characteristics and did not look at social characteristics such as neighborhood crime and safety or cultural reasons for walking rather than using another means of transportation," said Simons. "These characteristics also need to be studied and taken into account.”


Simons E, Dell SD, Moineddin R, To T. Associations between neighborhood walkability and incident and ongoing astham in children. Ann Am Thorac Soc. 2018;15(6):728—734. doi: 10.1513/AnnalsATS.201708-693OC.