Higher Neighborhood Drivability Is Associated With a Higher Diabetes Risk in Younger Adults: A Population-Based Cohort Study in Toronto, Canada.

Autor:	den Braver NR; Amsterdam University Medical Centers, Amsterdam, the Netherlands.; Upstream Team, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands., Beulens JWJ; Amsterdam University Medical Centers, Amsterdam, the Netherlands.; Upstream Team, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands., Wu CF; The Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada., Fazli GS; MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada., Gozdyra P; The Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada.; MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada., Howell NA; Department of Medicine, University of Toronto, Ontario, Canada., Lakerveld J; Amsterdam University Medical Centers, Amsterdam, the Netherlands.; Upstream Team, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands., Moin JS; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada., Rutters F; Amsterdam University Medical Centers, Amsterdam, the Netherlands., Brug J; National Institute for Public Health and the Environment, Bilthoven, the Netherlands., Moineddin R; The Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada.; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada., Booth GL; The Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada.; MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.; Department of Medicine, University of Toronto, Ontario, Canada.; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Jazyk:	angličtina
Zdroj:	Diabetes care [Diabetes Care] 2023 Jun 01; Vol. 46 (6), pp. 1177-1184.
DOI:	10.2337/dc22-1549
Abstrakt:	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. (© 2023 by the American Diabetes Association.)
Databáze:	MEDLINE
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