Living in more developed urban neighborhoods may reduce the risk of experiencing a first-time stroke, according to a University of Michigan study released on Mar. 19. The research followed over 25,000 adults across the United States for more than ten years and found that those residing in areas with higher development intensity had a 2.5% lower risk of suffering an initial stroke compared to people in less developed regions.
The findings are significant because they challenge common perceptions that urban environments, often associated with stress and pollution, are detrimental to health. Instead, the study suggests that certain features of city living—such as greater housing density, commercial outlets, and infrastructure like sidewalks and parks—may offer protective benefits against stroke.
Cathy Antonakos, research specialist senior at the University of Michigan School of Kinesiology and first author of the study, said the team used satellite data to measure development intensity over time around more than 34,000 residential locations. This approach moved beyond traditional static labels for urban or rural areas. "High-intensity development typically includes greater housing density and more commercial/retail outlets," she said. "These areas are more likely to feature compact land uses with access to health care, food stores, public transport and physical activity infrastructure like sidewalks, bike facilities and parks."
Antonakos also noted that while previous studies have produced inconsistent results regarding neighborhood development and stroke risk—often due to reliance on one-time classifications—the current research accounted for changes in neighborhood characteristics over time. The association between higher development intensity and reduced stroke risk remained even after adjusting for age, race, sex, diabetes, and high blood pressure.
The next phase of research will focus on identifying which specific environmental features most contribute to this protective effect. Antonakos said there are practical implications: "For physicians, the study suggests that neighborhood-level factors may influence first-time stroke risk, in addition to individual-level factors," she said. "For planners, the findings suggest that enhancing environments with features that support cardiovascular health and physical activity may help lower the risk of first-time stroke."
The study was supported by several grants from agencies including the National Institute of Neurological Disorders and Stroke (NINDS), National Institute on Aging (NIA), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), as well as computational resources from Advanced Research Computing at the University of Michigan.
