TY - JOUR
T1 - Higher Neighborhood Drivability Is Associated With a Higher Diabetes Risk in Younger Adults
T2 - A Population-Based Cohort Study in Toronto, Canada
AU - den Braver, Nicolette R
AU - Beulens, Joline W J
AU - Wu, C Fangyun
AU - Fazli, Ghazal S
AU - Gozdyra, Peter
AU - Howell, Nicholas A
AU - Lakerveld, Jeroen
AU - Moin, John S
AU - Rutters, Femke
AU - Brug, Johannes
AU - Moineddin, Rahim
AU - Booth, Gillian L
N1 - Funding Information: Funding. Financial support for this research was given by an Amsterdam Public Health Research Institute travel grant; a European Foundation for the Study of Diabetes Albert Renold Travel Fellowship; Canadian Institutes of Health Research operating funds; EXPOSOME-NL, funded through the Gravitation program of the Dutch Ministry of Education, Culture, and Science and the Netherlands Organization for Scientific Research (NWO grant 024.004.017); and EXPANSE, funded from the European Union’s Horizon 2020 research and innovation program under grant agreement 874627. Duality of Interest. No potential conflicts of interest relevant to this article were reported. Author Contributions. N.R.d.B. initiated the study, designed the analysis plan, interpreted results, and drafted the manuscript. J.W.J.B., G.S.F., P.G., N.A.H., J.L., J.S.M., F.R., J.B., and G.L.B. contributed to the conceptualization of the study, interpretation of the results, and major revisions of the manuscript. C.F.W. conducted all analyses. P.G. performed geographical analyses and support. R.M. provided advice for the statistical analyses. All authors critically read and approved the final submitted version of the manuscript. G.L.B. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Publisher Copyright: © 2023 by the American Diabetes Association.
PY - 2023/6/1
Y1 - 2023/6/1
N2 - OBJECTIVE: Car dependency contributes to physical inactivity and, consequently, may increase the likelihood of diabetes. We investigated whether neighborhoods that are highly conducive to driving confer a greater risk of developing diabetes and, if so, whether this differs by age. RESEARCH DESIGN AND METHODS: We used administrative health care data to identify all working-age Canadian adults (20-64 years) who were living in Toronto on 1 April 2011 without diabetes (type 1 or 2). Neighborhood drivability scores were assigned using a novel, validated index that predicts driving patterns based on built environment features divided into quintiles. Cox regression was used to examine the association between neighborhood drivability and 7-year risk of diabetes onset, overall and by age-group, adjusting for baseline characteristics and comorbidities. RESULTS: Overall, there were 1,473,994 adults in the cohort (mean age 40.9 ± 12.2 years), among whom 77,835 developed diabetes during follow-up. Those living in the most drivable neighborhoods (quintile 5) had a 41% higher risk of developing diabetes compared with those in the least drivable neighborhoods (adjusted hazard ratio 1.41, 95% CI 1.37-1.44), with the strongest associations in younger adults aged 20-34 years (1.57, 95% CI 1.47-1.68, P < 0.001 for interaction). The same comparison in older adults (55-64 years) yielded smaller differences (1.31, 95% CI 1.26-1.36). Associations appeared to be strongest in middle-income neighborhoods for younger residents (middle income 1.96, 95% CI 1.64-2.33) and older residents (1.46, 95% CI 1.32-1.62). CONCLUSIONS: High neighborhood drivability is a risk factor for diabetes, particularly in younger adults. This finding has important implications for future urban design policies.
AB - OBJECTIVE: Car dependency contributes to physical inactivity and, consequently, may increase the likelihood of diabetes. We investigated whether neighborhoods that are highly conducive to driving confer a greater risk of developing diabetes and, if so, whether this differs by age. RESEARCH DESIGN AND METHODS: We used administrative health care data to identify all working-age Canadian adults (20-64 years) who were living in Toronto on 1 April 2011 without diabetes (type 1 or 2). Neighborhood drivability scores were assigned using a novel, validated index that predicts driving patterns based on built environment features divided into quintiles. Cox regression was used to examine the association between neighborhood drivability and 7-year risk of diabetes onset, overall and by age-group, adjusting for baseline characteristics and comorbidities. RESULTS: Overall, there were 1,473,994 adults in the cohort (mean age 40.9 ± 12.2 years), among whom 77,835 developed diabetes during follow-up. Those living in the most drivable neighborhoods (quintile 5) had a 41% higher risk of developing diabetes compared with those in the least drivable neighborhoods (adjusted hazard ratio 1.41, 95% CI 1.37-1.44), with the strongest associations in younger adults aged 20-34 years (1.57, 95% CI 1.47-1.68, P < 0.001 for interaction). The same comparison in older adults (55-64 years) yielded smaller differences (1.31, 95% CI 1.26-1.36). Associations appeared to be strongest in middle-income neighborhoods for younger residents (middle income 1.96, 95% CI 1.64-2.33) and older residents (1.46, 95% CI 1.32-1.62). CONCLUSIONS: High neighborhood drivability is a risk factor for diabetes, particularly in younger adults. This finding has important implications for future urban design policies.
UR - http://www.scopus.com/inward/record.url?scp=85160021525&partnerID=8YFLogxK
U2 - https://doi.org/10.2337/dc22-1549
DO - https://doi.org/10.2337/dc22-1549
M3 - Article
C2 - 36950930
SN - 0149-5992
VL - 46
SP - 1177
EP - 1184
JO - Diabetes Care
JF - Diabetes Care
IS - 6
ER -