Background. Seventy-five percent of the population in Europe live in urban areas, so analysing the effects of urban form on health is of public health interest. However, research in recent years has focussed on health benefits of specific characteristics such as green space or walkability rather than multiple aspects of urban form. Aim. A novel approach was used to investigate associations between different measures of urban form and mortality risks in cities in England and Wales. Methods. An ecological, cross-sectional study was conducted for 54 cities with more than 200,000 residents. Linear regression models were used to examine the associations between city-level measures of urban form (distribution and density of population, land cover, transport networks, location, altitude range, city structure) and age-sex standardised risks of deaths from all causes (including accdients) and cardiovascular disease with adjustment for a a smoking proxy and area-level deprivation. Results.The most consistent pattern of associations were seen with transport network patterns, especially high junction density. Women ＜65 years living in cities with high junction density had a relative risk (RR) for CVD mortality of 1.16 (1.10-1.22) compared to those living in cities with the lowest junction density; corresponding risk for men was 1.12 (1.09 - 1.16). Relatives risks were higher with premature than all-cause mortality and in females compared with males. Smaller and less consistent associations could be detected with land cover or population patterns. Conclusion. Associations between urban form and mortality can highlight characteristics of city structure that potentially have negative effects on the health of urban communities. Further examination of urban form is warranted, to inform future urban planning and regeneration strategies including examination of different outcomes such as respiratory disease and road-traffic accidents.
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