Is the built environment associated with morbidity and mortality? A systematic review of evidence from Germany

The empirical evidence on this relationship mainly comes from Anglo-American countries whereas evidence from Germany is only emerging. Our objective is to provide a narrative overview and critical appraisal of the existing empirical evidence on the relationship between the built environment and morbidity/mortality in Germany. We conducted a systematic literature search where we included all empirical studies that linked the built environment aspects with morbidity or mortality outcomes. Findings were summarized and critically evaluated according to the Newcastle Ottawa Scale. Eighteen studies met the inclusion criteria and underwent in-depth analysis. Findings indicate that traffic exposure and green space tend to be associated with acute respiratory symptoms but not with chronic respiratory conditions. Evidence was inconsistent for the role of infrastructural aspects and urbanicity. Our review confirms the well-established association between traffic and respiratory health. Yet, the consistency between self-reported and objective measures of respiratory health should be investigated in more detail.