Abstract: Objective To evaluate the association between self-reported neighborhood walkability environments and mortality in China. Methods The Prospective Urban Rural Epidemiology study in China(PURE-China) recruited 47 931 participants aged 35-70 from 12 provinces in China between 2005 and 2009. Neighborhood environmental indicators were collected using the Neighborhood Environment Walkability Scale(NEWS) questionnaire,with higher scores indicating better walkable environments. The primary outcomes were all-cause mortality and cardiovascular mortality,using Cox fragile model to evaluate the association between community walkability and outcomes,as well as exploring mediating pathways. Results Of 35 490 participants included in this study,60% were female,with a mean(SD) age of 51.5(9.6) years. The median follow-up was 11.7 years. This study found an association between higher community walkability score and reduced risk of all-cause mortality,with the total score(HR=0.85; 95% CI,0.80-0.89),land-use mix(HR=0.84; 95% CI,0.79-0.88),and crime safety(HR=0.84; 95% CI,0.80-0.89) showing the most significant associations. NEWS can affect long-term adverse outcomes through lifestyle. Conclusions In the Chinese population,favorable community walkability is associated with lower all-cause mortality risk,which may support policymakers to take actions to mitigate the adverse effects of poor community environments on health.

Key words: mortality, neighborhood environment walkability, mediation analysis, cohort study, Cox frailty model