Articlegold2020

Neighborhood walkability and pre-diabetes incidence in a multiethnic population

Ghazal S. Fazli · Rahim Moineddin · Anna Chu · Arlene S. Bierman · Gillian L. Booth

24 citations0/0 files storedBMJ Open Diabetes Research & Care

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Urban Transport and Accessibility Diabetes, Cardiovascular Risks, and Lipoproteins Urban Green Space and Health

Abstract

INTRODUCTION: We examined whether adults living in highly walkable areas are less likely to develop pre-diabetes and if so, whether this association is consistent according to immigration status and ethnicity. RESEARCH DESIGN AND METHODS: Population-level health, immigration, and administrative databases were used to identify adults aged 20-64 (n=1 128 181) who had normoglycemia between January 2011 and December 2011 and lived in one of 15 cities in Southern Ontario, Canada. Individuals were assigned to one of ten deciles (D) of neighborhood walkability (from lowest (D1) to highest (D10)) and followed until December 2013 for the development of pre-diabetes. RESULTS: Overall, 220 225 individuals in our sample developed pre-diabetes during a median follow-up of 8.4 years. Pre-diabetes incidence was 20% higher among immigrants living in the least (D1) (adjusted HR 1.20, 95% CI 1.15 to 1.25, p<0.0001) versus most (D10, referent) walkable neighborhoods after accounting for age, sex, and area income. Findings were similar among long-term residents and across sexes. However, susceptibility to walkability varied by ethnicity where D1 versus D10 adjusted HRs ranged from 1.17 (95% CI 1.02 to 1.35, p=0.03) among West Asian and Arab immigrants to 1.32 (95% CI 1.19 to 1.47, p<0.0001) in Southeast Asians. Ethnic variation in pre-diabetes incidence was more marked in low walkability settings. Relative to Western Europeans, the adjusted HR for pre-diabetes incidence was 2.11 (95% CI 1.81 to 2.46, p<0.0001) and 1.50 (95% CI 1.27 to 1.77, p<0.0001) among Sub-Saharan African and the Carribean and Latin American immigrants, respectively, living in the least walkable (D1) neighborhoods, but only 1.24 (95% CI 1.08 to 1.42, p=0.002) and 1.00 (95% CI 0.87 to 1.15, p=0.99) for these same groups living in the most walkable (D10) neighborhoods. CONCLUSIONS: Pre-diabetes incidence was reduced in highly walkable areas for most groups living in Southern Ontario cities. These findings suggest a potential role for walkable urban design in diabetes prevention.

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References

2016Physical activity in relation to urban environments in 14 cities worldwide: a cross-sectional study 2012The 10-Year Cost-Effectiveness of Lifestyle Intervention or Metformin for Diabetes Prevention 2016Association of Neighborhood Walkability With Change in Overweight, Obesity, and Diabetes 2009Are immigrant enclaves healthy places to live? The Multi-ethnic Study of Atherosclerosis 2017Identifying mechanisms for facilitating knowledge to action strategies targeting the built environment 2009Neighborhood resources for physical activity and healthy foods and incidence of type 2 diabetes mellitus: the Multi-Ethnic study of Atherosclerosis.2016Describing the linkages of the immigration, refugees and citizenship Canada permanent resident data and vital statistics death registry to Ontario’s administrative health database 2014Density, Destinations or Both? A Comparison of Measures of Walkability in Relation to Transportation Behaviors, Obesity and Diabetes in Toronto, Canada

Cited by

2022Neighborhood Environment and Metabolic Risk in Hispanics/Latinos From the Hispanic Community Health Study/Study of Latinos 2024The Healthy City Reimagined: Walkability, Active Mobility, and the Challenges of Measurement and Evaluation 2022Impact of land use and food environment on risk of type 2 diabetes: A national study of veterans, 2008–2018

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