Background: Perceptions of salient neighborhood attributes influence health behaviours, with a subsequent impact on lifestyle related diseases. We investigated the role played by such perceptions in the association between neighborhood disadvantage and arthritis.
Methods: We used survey data from 9,914 population-based adults (40-65yrs) from 200 neighborhoods in Brisbane, Australia (54.6% women). Perceptions of the neighborhood were measured using the Neighborhood Environment Walkability Scale. Principal Components Analysis was used to develop six Walkability Scales; crime/safety, physical surroundings, streets/footpaths, traffic volume, incivilities (litter, graffiti), and neighborliness. Neighborhood disadvantage was measured using a census-based composite index, and individual disadvantage measured by self-reported demographics. Data were analysed using cross-sectional multilevel modelling.
Results: Prevalence of self-reported arthritis was 23% overall, with a higher proportion in the most vs. least disadvantaged quintile (32% vs. 18%): this held for women (34.7% vs. 22.0%) and men (27.7% vs. 14.5%). Across all quintiles of disadvantage, the largest reductions in OR were observed after adjustment for perceptions of crime and safety, with smaller reductions after adjusting for physical surroundings, traffic volume and incivilities. These results were similar among women and men except for neighborliness, where there was a reduction among women and an increase among men.
Conclusion: Self-reported arthritis was greater and walkability perceptions lower in disadvantaged neighborhoods, independent of individual disadvantage. Whilst negative perceptions of the neighborhood may act as a barrier to using the outdoor environment for specific populations, further work is necessary to elucidate the role that walkability perceptions (as mediators) play in arthritis prevalence.