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Int. J. Environ. Res. Public Health 2019, 16(8), 1350;

Urban Sprawl and Health Outcome Associations in Sicily

Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Via del Vespro 131, 90127 Palermo, Italy
Department of Health Services and Epidemiological Observatory, Regional Health Authority, Sicilian Region, Via Mario Vaccaro 5, 90145 Palermo, Italy
Author to whom correspondence should be addressed.
Received: 10 March 2019 / Revised: 12 April 2019 / Accepted: 13 April 2019 / Published: 15 April 2019
(This article belongs to the Section Environmental Health)
PDF [317 KB, uploaded 15 April 2019]


Urban sprawl has several negative impacts on the environment, the economy, and human health. The main objective of this work was to formulate and validate a sprawl/compactness index for Sicilian municipalities and evaluate its association with health outcomes. An ecological study was conducted with 110 municipalities in Sicily, Italy. Principal component analysis was adopted to create the sprawl/compactness Sicilian index, and linear regression analysis was used to evaluate the association between the sprawl index and health outcomes. More variance of the new sprawl index was explained by the working factor, followed by density, surface extension, and land use mix. When validating the index, we found that public transportation had an inverse relation with sprawl increase (p < 0.001), and private transportation was directly related to the increase in sprawl (p < 0.001). After controlling for the Sicilian socio-economic deprivation index and overall mortality, cardiovascular mortality was the only outcome directly associated with the increase in the sprawl index (odds ratio = 0.0068, p < 0.001). Urban sprawl has to be monitored in Sicily over time to understand the evolution of the urbanization phenomenon and its relationship with health outcomes such as cardiovascular mortality. The use of the sprawl index should help policymakers define the necessary strategic aspects and actions to improve human health and quality of life in cities through a multi-sectorial approach.
Keywords: urban sprawl; sprawl index; working activity; urban health; cardiovascular; transportation urban sprawl; sprawl index; working activity; urban health; cardiovascular; transportation
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).

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Restivo, V.; Cernigliaro, A.; Casuccio, A. Urban Sprawl and Health Outcome Associations in Sicily. Int. J. Environ. Res. Public Health 2019, 16, 1350.

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Int. J. Environ. Res. Public Health EISSN 1660-4601 Published by MDPI AG, Basel, Switzerland RSS E-Mail Table of Contents Alert
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