Compact walkable environments with greenspace support physical activity and reduce the risk for depression and several obesity-related chronic diseases, including diabetes and heart disease. Recent evidence confirms that these chronic diseases increase the severity of COVID-19 infection and mortality risk. Conversely, denser transit supportive environments may increase risk of exposure to COVID-19 suggesting the potential for contrasting chronic versus infectious disease impacts of community design. A handful of recent studies have examined links between density and COVID-19 mortality rates reporting conflicting results. Population density has been used as a surrogate of urban form to capture the degree of walkability and public transit versus private vehicle travel demand. The current study employs a broader range of built environment features (density, design, and destination accessibility) and assesses how chronic disease mediates the relationship between built and natural environment and COVID-19 mortality. Negative and significant relationships are observed between built and natural environment features and COVID-19 mortality when accounting for the mediating effect of chronic disease. Findings underscore the importance of chronic disease when assessing relationships between COVID-19 mortality and community design. Based on a rigorous simulation-assisted random parameter path analysis framework, we further find that the relationships between COVID-19 mortality, obesity, and key correlates exhibit significant heterogeneity. Ignoring this heterogeneity in highly aggregate spatial data can lead to incorrect conclusions with regards to the relationship between built environment and COVID-19 transmission. Results presented here suggest that creating walkable environments with greenspace is associated with reduced risk of chronic disease and/or COVID-19 infection and mortality.

带绿地的紧凑型步行环境支持体育锻炼，并降低患抑郁症和多种与肥胖相关的慢性疾病（包括糖尿病和心脏病）的风险。最近的证据证实，这些慢性病会增加 COVID-19 感染的严重程度和死亡风险。相反，更密集的交通支持环境可能会增加接触 COVID-19 的风险，这表明社区设计可能会对慢性病和传染病的影响进行对比。最近的一些研究调查了密度和 COVID-19 死亡率之间的联系，报告了相互矛盾的结果。人口密度已被用作城市形态的替代指标，以捕捉步行和公共交通与私家车出行需求的程度。当前的研究采用更广泛的建筑环境特征（密度、设计和目的地可达性），并评估慢性病如何调节建筑环境和自然环境与 COVID-19 死亡率之间的关系。在考虑慢性病的中介作用时，在建筑和自然环境特征与 COVID-19 死亡率之间观察到负向且显着的关系。在评估 COVID-19 死亡率与社区设计之间的关系时，调查结果强调了慢性病的重要性。基于严格的模拟辅助随机参数路径分析框架，我们进一步发现 COVID-19 死亡率、肥胖和关键相关因素之间的关系表现出显着的异质性。忽略高度聚合空间数据中的这种异质性可能会导致关于建筑环境与 COVID-19 传播之间关系的错误结论。此处显示的结果表明，创建带绿地的步行环境与降低慢性病和/或 COVID-19 感染和死亡率的风险有关。