People who live in sprawling communities tend to suffer more health problems, according to the first study to document a link between the world of strip malls, cul-de-sacs and subdivisions and a broad array of ailments.

The study, which analyzed data on more than 8,600 Americans in 38 metropolitan areas -- including the Washington region -- found that rates of arthritis, asthma, headaches and other complaints increased with the degree of sprawl. Living in areas with the least amount of sprawl, compared with living in areas with the most, was like adding about four years to people's lives in terms of their health, the study found.

"Suburban sprawl affects your health," said Roland Sturm, a senior economist at the Rand Corp. of Santa Monica, Calif., who led the study, which is being released today. "That's really the take-home message."

As suburbia has spread across the American landscape, health experts have become increasingly concerned that the fast-food, car-dependent lifestyle may be contributing to a host of health problems. Previous studies have linked sprawl to an increased risk of being overweight and obese and certain related health problems, such as high blood pressure. The new study, published in the journal Public Health, is the first to directly examine the relationship between sprawl and a wide spectrum of chronic illnesses.

"This is the first one where we assess a whole set of conditions," Sturm said. "That's the new angle."

The increase in health problems is presumably due to the fact that sprawl discourages physical activity, increasing the chances of being overweight or obese. In addition, sprawling communities tend to have more air pollution, Sturm said.

"This really seems to be due mainly to air pollution and physical activity," Sturm said.

Sturm and colleague Deborah Cohen analyzed data collected by Healthcare for Communities, a survey that in 1998 and 2001 questioned a nationally representative sample of 8,686 adults in 38 areas about a range of health issues. The researchers then examined whether there was an association between 16 health problems and the amount of sprawl where participants lived, using a scale that includes such measures as population density, street patterns and proximity of businesses and workplaces to residences.

The least compact community was the Riverside-San Bernardino area in California, while the most was Manhattan. The Washington area ranked 15th most sprawling; Baltimore ranked the ninth least sprawling.

People living in areas that scored highest on the sprawl scale reported the most problems, with the unhealthful effects appearing to disproportionately affect the poor and the elderly. The association was particularly significant with arthritis, respiratory problems such as asthma, stomach problems, headaches and urinary tract infections. But the researchers also found some evidence of an association with heart disease and high blood pressure.

Very spread out places, such as Atlanta, had about 100 more health problems per 1,000 people than areas that were less so, such as the Greensboro-Winston Salem area of North Carolina. Washington had about 50 more health problems per 1,000 people than Baltimore, Sturm said.

Although some researchers have speculated that the social isolation that can occur in sprawling communities may also lead to more mental health problems, such as depression, the new study failed to find that link.

"We find a strong association on the physical health side, but surprisingly not on the mental health side," Sturm said in a telephone interview.

Other researchers praised the study, saying it adds to evidence that suggests the physical attributes of where a person lives can have a significant impact on their health.

"It's the first study to aggressively assess systematic relations between health outcomes and the built environment," said Lawrence D. Frank of the University of British Columbia, who studies sprawl.

"This is still a very new field of research, but every significant study that has come out so far has reached a similar conclusion," said Don Chen, executive director of Smart Growth America, a Washington-based advocacy group. "This may be a promising way to begin addressing some of these chronic health issues."

But critics dismissed the findings, saying the study was flawed and the link between sprawl and health was tenuous at best.

"I remain a skeptic of the research, in part because the results they find are weak," said Samuel R. Staley, a senior fellow at the Reason Foundation, a Los Angeles-based libertarian group. "This study seems particularly prone to spurious results -- results that are statistically related but really don't tell us much about causes."

Peter Gordon, a professor in the school of policy, planning and development at the University of Southern California in Los Angeles agreed, calling the study "junk science." The areas studied, for example, are so large they could not distinguish important neighborhood differences, he said.

"Describing places this large via a simple ad hoc 'sprawl' index is nuts," Gordon wrote in an e-mail. "People have been suburbanizing for a very long time. Yet, life expectancy keeps getting longer."