‎The association between cumulative exposure to neighborhood walkability (NW) and diabetes risk, a prospective cohort study

Ann Epidemiol. 2024 Dec:100:27-33. doi: 10.1016/j.annepidem.2024.10.007. Epub 2024 Oct 21.

Abstract

Purpose: To examine the association between cumulative exposure to neighborhood walkability (NW) and diabetes risk.

Methods: A total of 11,037 women free of diabetes at enrollment were included. We constructed a 4-item NW index at baseline, and a 2-item average annual NW across years of follow-up that captured both changes in neighborhood features and residential moves. We used multivariable Cox PH regression models with robust variance to estimate the hazard ratios (HRs) of diabetes by NW scores.

Results: Compared with women living in areas with lowest NW (Q1), those living in areas with highest NW (Q4) had 33 % (26 %-39 %) reduced risk of incident diabetes, using baseline NW, and 25 % (95 % CI 11 %-36 %), using average annual NW. Analysis using time-varying exposure showed that diabetes risks decreased by 13 % (10 %-16 %) per -standard deviation increase in NW. The associations remained similar when using inverse probability of attrition weights and/or competing risk models to account for the effect of censoring due to death or non-response. The associations of average annual NW with incident diabetes were stronger in postmenopausal women as compared to premenopausal women.

Conclusion: Long-term residence in more walkable neighborhoods may be protective against diabetes in women, especially postmenopausal women.

Keywords: Diabetes; Neighborhood environment; Physical activity; Urban; Women.

MeSH terms

  • Adult
  • Diabetes Mellitus / epidemiology
  • Diabetes Mellitus, Type 2 / epidemiology
  • Environment Design
  • Female
  • Humans
  • Incidence
  • Middle Aged
  • Neighborhood Characteristics
  • Proportional Hazards Models
  • Prospective Studies
  • Residence Characteristics* / statistics & numerical data
  • Risk Factors
  • Walking* / statistics & numerical data