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

Amy H. Auchincloss

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Urban Transport and Accessibility Health disparities and outcomes Urban Green Space and Health

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 (> or =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.

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References

2005Increasing walking 2005Correlation or causality between the built environment and travel behavior? Evidence from Northern California 2001Environmental and Policy Determinants of Physical Activity in the United States 2007Assessing the Measurement Properties of Neighborhood Scales: From Psychometrics to Ecometrics 2004Physical Activity and Environment Research in the Health Field: Implications for Urban and Transportation Planning Practice and Research 2008Relation between Neighborhood Environments and Obesity in the Multi-Ethnic Study of Atherosclerosis 2008Neighborhood Resources for Physical Activity and Healthy Foods and Their Association With Insulin Resistance 2002Neighborhood Characteristics and Components of the Insulin Resistance Syndrome in Young Adults

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2010Neighborhoods and health 2020Social Determinants of Health and Diabetes: A Scientific Review 2015Social Determinants of Risk and Outcomes for Cardiovascular Disease 2018Environmental Risk Factors for Developing Type 2 Diabetes Mellitus: A Systematic Review 2012

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