Community severance and health – A novel approach to measuring community severance and examining its impact on the health of adults in Great Britain

Aspects of community severance (the separation of people from goods, services, and each other by busy roads or other transport infrastructure) have been linked to poor health and wellbeing, but few studies have examined this relationship. We created a novel index for community severance and estimated its association with the self-rated health of adults in Great Britain. Data were collected from a nationally representative online panel survey of 4,111 participants, February–July 2016. To construct an index, polychoric factor analysis (suitable for ordinal variables), was conducted on four survey items related to the perceived impact of roads on ability to walk locally. Community severance index (CSI) scores were negatively skewed, so were categorised into four groups (lowest 40%, second, third, highest). We examined the association of community severance with self-rated health ‘poor’ (fair/bad/very bad)) versus (‘good’ (very good/good) using logistic regression, adjusting for potential confounders (age, income, employment status). Polychoric factor analysis confirmed that it was appropriate to combine the four survey items into a single index (Cronbach’s Alpha = 0.86; Keiser-Meyer-Olkin measure of sampling adequacy = 0.76, factor loadings >0.74). After controlling for confounding factors, being in the highest CSI group was associated with higher odds of reporting poor self-rated health (Odds Ratio: 1.79, 95% Confidence Interval: 1.48–2.17) compared with the lowest CSI group. There was a dose-response gradient, with those in the second and third highest CSI groups also having increased odds of reporting poor self-rated health, though of lower magnitude ((1.21, 95% CI 1.01–1.45) and (1.41, 95% CI 1.16–1.71) respectively). We found an inverse association between CSI and self-rated health. This suggests that to improve health, local governments and road authorities should take steps to reduce community severance through traffic reduction and calming, pedestrian prioritisation, and the installation of well-designed crossing points.