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Journal article
Mediation of an association between neighborhood socioeconomic environment and type 2 diabetes through the leisure-time physical activity environment in an analysis of three independent samples
BMJ open diabetes research & care, v 11(2), e003120
01 Mar 2023
PMID: 36858436
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
IntroductionInequitable access to leisure-time physical activity (LTPA) resources may explain geographic disparities in type 2 diabetes (T2D). We evaluated whether the neighborhood socioeconomic environment (NSEE) affects T2D through the LTPA environment.Research design and methodsWe conducted analyses in three study samples: the national Veterans Administration Diabetes Risk (VADR) cohort comprising electronic health records (EHR) of 4.1 million T2D-free veterans, the national prospective cohort REasons for Geographic and Racial Differences in Stroke (REGARDS) (11 208 T2D free), and a case–control study of Geisinger EHR in Pennsylvania (15 888 T2D cases). New-onset T2D was defined using diagnoses, laboratory and medication data. We harmonized neighborhood-level variables, including exposure, confounders, and effect modifiers. We measured NSEE with a summary index of six census tract indicators. The LTPA environment was measured by physical activity (PA) facility (gyms and other commercial facilities) density within street network buffers and population-weighted distance to parks. We estimated natural direct and indirect effects for each mediator stratified by community type.ResultsThe magnitudes of the indirect effects were generally small, and the direction of the indirect effects differed by community type and study sample. The most consistent findings were for mediation via PA facility density in rural communities, where we observed positive indirect effects (differences in T2D incidence rates (95% CI) comparing the highest versus lowest quartiles of NSEE, multiplied by 100) of 1.53 (0.25, 3.05) in REGARDS and 0.0066 (0.0038, 0.0099) in VADR. No mediation was evident in Geisinger.ConclusionsPA facility density and distance to parks did not substantially mediate the relation between NSEE and T2D. Our heterogeneous results suggest that approaches to reduce T2D through changes to the LTPA environment require local tailoring.
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Details
- Title
- Mediation of an association between neighborhood socioeconomic environment and type 2 diabetes through the leisure-time physical activity environment in an analysis of three independent samples
- Creators
- Katherine A Moon - Bloomberg (United States)Cara M Nordberg - Geisinger Health SystemStephanie L Orstad - New York UniversityAowen Zhu - University of Alabama at BirminghamJalal Uddin - University of Alabama at BirminghamPriscilla Lopez - New York UniversityMark D Schwartz - New York UniversityVictoria Ryan - Drexel UniversityAnnemarie G Hirsch - Geisinger Health SystemBrian S Schwartz - Bloomberg (United States)April P Carson - University of Mississippi Medical CenterD Leann Long - University of Alabama at BirminghamMelissa Meeker - Drexel UniversityJanene Brown - Drexel UniversityGina S Lovasi - Drexel UniversitySamranchana Adhikari - New York UniversityRania Kanchi - New York UniversitySanja Avramovic - George Mason UniversityGiuseppina Imperatore - Centers for Disease Control and PreventionMelissa N Poulsen - Geisinger Health System
- Publication Details
- BMJ open diabetes research & care, v 11(2), e003120
- Publisher
- American Diabetes Association
- Number of pages
- 14
- Grant note
- U01DP006293; U01DP006296; U01DP006299; U01DP006302 / Diabetes LEAD Network Not applicable / the Built Environment and Health Research Group at Columbia University SAP #4100072543 / Pennsylvania Department of Health (http://dx.doi.org/10.13039/100004897) U01 NS041588 / National Institute of Neurological Disorders and Stroke (NINDS) and the National Institute on Aging (NIA) Not applicable / Urban Health Collaborative at Drexel University 1R01AG049970; 3R01AG049970-04S1 / National Institute of Aging
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Urban Health Collaborative; Epidemiology and Biostatistics
- Web of Science ID
- WOS:000949834200003
- Scopus ID
- 2-s2.0-85149427185
- Other Identifier
- 991020186998304721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Endocrinology & Metabolism