Neighborhood Resources for Physical Activity and Healthy Foods and Incidence of Type 2 Diabetes Mellitus

Abstract

Background Despite increasing interest in the extent to which features of residential environments contribute to incidence of type 2 diabetes mellitus, no multisite prospective studies have investigated this question. We hypothesized that neighborhood resources supporting physical activity and healthy diets are associated with a lower incidence of type 2 diabetes. Methods Person-level data came from 3 sites of the Multi-Ethnic Study of Atherosclerosis, a population-based, prospective study of adults aged 45 to 84 years at baseline. Neighborhood data were derived from a population-based residential survey. Type 2 diabetes was defined as a fasting glucose level of 126 mg/dL or higher (≥7 mmol/L) or taking insulin or oral hypoglycemic agents. We estimated the hazard ratio of type 2 diabetes incidence associated with neighborhood (US Census tract) resources. Results Among 2285 participants, 233 new type 2 diabetes cases occurred during a median of 5 follow-up years. Better neighborhood resources, determined by a combined score for physical activity and healthy foods, were associated with a 38% lower incidence of type 2 diabetes (hazard ratio corresponding to a difference between the 90th and 10th percentiles for resource distribution, 0.62; 95% confidence interval, 0.43–0.88 adjusted for age, sex, family history of diabetes, race/ethnicity, income, assets, educational level, alcohol use, and smoking status). The association remained statistically significant after further adjustment for individual dietary factors, physical activity level, and body mass index. Conclusion Better neighborhood resources were associated with lower incidence of type 2 diabetes, which suggests that improving environmental features may be a viable population-level strategy for addressing this disease.

Social Determinants of Risk and Outcomes for Cardiovascular Disease

“…After an average of 5 years of follow-up, participants 45 to 84 years of age at baseline and of diverse racial and ethnic backgrounds had a 38% lower risk of type II diabetes mellitus and 10% lower risk of obesity independently of individual-level confounders and health behaviors. 104,105 These associations are supported by other cross-sectional studies, and the most consistent evidence is in relation to neighborhood built/physical environment and obesity/BMI. In a review of 20 studies investigating this link among studies published between 2002 and 2006, 17 studies found a positive association between neighborhood built environment and obesity.…”

Built Environment, Physical Activity and Diabetes

“…Studies of BE acknowledge that aspects of physical surroundings can shape choices about diet and PA, both important contributors to the development of diabetes. A 5-year followup study found that better neighbourhood resources, based on a composite score for healthy foods and PA, were associated with a 38% lower incidence of T2DM 79 . A highly comprehensive study of diabetes and neighbourhood environments was conducted in 140 Toronto neighbourhoods, which assessed the relationship between diabetes and factors such as socio-economic status, ethnic composition, crime rates, car ownership, public transportation, access to healthy food, opportunities for PA, and access to healthcare and other services.…”

Does location matter? A proposed methodology to evaluate neighbourhood effects on cardiac arrest survival and bystander CPR

“…The patient's home neighbourhood will be used as a surrogate for patient characteristics, because previous literature shows an association between home neighbourhood and cardiac risk factors, unhealthy behaviours, and overall health. [33][34][35][36][37][38][39][40][41][42][43][44][45] The neighbourhood factors of the arrest location (i.e., the pickup address) will be used to study the effects on bystander CPR, because the emergency response (i.e., bystanders and EMS/paramedics) is contingent on the arrest location. [10][11][12][13][46][47][48] A patient's home address is recorded as mailing address with street name, street number, and postal code, whereas the pickup address is recorded as a mailing address, with latitude and longitude coordinates and a Universal Transverse Mercator (UTM) value.…”