Unwalkable Neighborhoods, Poverty, and the Risk of Diabetes Among Recent Immigrants to Canada Compared With Long-Term Residents

Centre for Research on Inner City Health, The Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital
Diabetes care (Impact Factor: 8.42). 09/2012; 36(2). DOI: 10.2337/dc12-0777
Source: PubMed

This study was designed to examine whether residents living in neighborhoods that are less conducive to walking or other physical activities are more likely to develop diabetes and, if so, whether recent immigrants are particularly susceptible to such effects.METHODS
We conducted a population-based, retrospective cohort study to assess the impact of neighborhood walkability on diabetes incidence among recent immigrants (n = 214,882) relative to long-term residents (n = 1,024,380). Adults aged 30-64 years who were free of diabetes and living in Toronto, Canada, on 31 March 2005 were identified from administrative health databases and followed until 31 March 2010 for the development of diabetes, using a validated algorithm. Neighborhood characteristics, including walkability and income, were derived from the Canadian Census and other sources.RESULTSNeighborhood walkability was a strong predictor of diabetes incidence independent of age and area income, particularly among recent immigrants (lowest [quintile 1 {Q1}] vs. highest [quintile 5 {Q5}] walkability quintile: relative risk [RR] 1.58 [95% CI 1.42-1.75] for men; 1.67 [1.48-1.88] for women) compared with long-term residents (Q1 to Q5) 1.32 [1.26-1.38] for men; 1.24 [1.18-1.31] for women). Coexisting poverty accentuated these effects; diabetes incidence varied threefold between recent immigrants living in low-income/low walkability areas (16.2 per 1,000) and those living in high-income/high walkability areas (5.1 per 1,000).CONCLUSIONS
Neighborhood walkability was inversely associated with the development of diabetes in our setting, particularly among recent immigrants living in low-income areas.

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    • "However, while the relationship between the built environment (e.g., street connectivity, traffic exposure, residential density, access to destinations) and walking is accumulating, few studies have investigated the relationship between the built environment and diabetes (self-reported or clinically-measured) [16]. These studies have reported that people living in more walkable neighbourhoods are less likely to report cardiometabolic risk factors that are closely associated with diabetes [17,18], whereas the presence of healthy food stores and restaurants [19], sport and recreation venues has been negatively associated with Type 2 diabetes [19]. However, to our knowledge, no studies have considered direct associations between other discrete environment features, such as the topography (hilliness), with Type 2 diabetes [16]. "
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    ABSTRACT: Variations in 'slope' (how steep or flat the ground is) may be good for health. As walking up hills is a physiologically vigorous physical activity and can contribute to weight control, greater neighbourhood slopes may provide a protective barrier to weight gain, and help prevent Type 2 diabetes onset. We explored whether living in 'hilly' neighbourhoods was associated with diabetes prevalence among the Australian adult population. Participants (>=25 years; n = 11,406) who completed the Western Australian Health and Wellbeing Surveillance System Survey (2003-2009) were asked whether or not they had medically-diagnosed diabetes. Geographic Information Systems (GIS) software was used to calculate a neighbourhood mean slope score, and other built environment measures at 1600 m around each participant's home. Logistic regression models were used to predict the odds of self-reported diabetes after progressive adjustment for individual measures (i.e., age, sex), socioeconomic status (i.e., education, income), built environment, destinations, nutrition, and amount of walking. After full adjustment, the odds of self-reported diabetes was 0.72 (95% CI 0.55-0.95) and 0.52 (95% CI 0.39-0.69) for adults living in neighbourhoods with moderate and higher levels of slope, respectively, compared with adults living in neighbourhoods with the lowest levels of slope. The odds of having diabetes was 13% lower (odds ratio 0.87; 95% CI 0.80-0.94) for each increase of one percent in mean slope. Living in a hilly neighbourhood may be protective of diabetes onset or this finding is spurious. Nevertheless, the results are promising and have implications for future research and the practice of flattening land in new housing developments.
    International Journal of Health Geographics 12/2013; 12(1):59. DOI:10.1186/1476-072X-12-59 · 2.62 Impact Factor
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    • "This startling increase in incidence in the Chinese population was even more dramatic when adjusted for diabetes risk factors such as obesity and income. The cause of this increase is unknown but may be due to rising acculturation, the adoption of unhealthy lifestyle habits, or migration of Chinese populations from densely populated urban areas to suburban communities associated with greater diabetes risk (9). "
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    ABSTRACT: OBJECTIVE To examine trends in diabetes incidence among Ontario residents with Chinese and European origins.RESEARCH DESIGN AND METHODS Respondents to population-based health surveys in 1996, 2001, 2003, and 2005 who were aged ≥30 years, who did not have diabetes, and who self-identified as having European (n = 76,285) or Chinese (n = 1,041) origins were followed for diabetes incidence through a validated administrative data-derived diabetes registry.RESULTSAge- and sex-standardized diabetes incidence increased from 1.3 to 19.6 per 1,000 person-years in the Chinese population and from 7.8 to 10.0 in the European population. Relative to the 1996 European population, the adjusted hazard ratio for diabetes was 4.50 (95% CI 1.89-7.49) for the 2005 Chinese population and 1.22 (1.05-1.39) for the 2005 European population.CONCLUSIONS Diabetes incidence increased much more rapidly between 1996 and 2005 in the Chinese population than in the European population, independent of age, obesity, and other risk factors.
    Diabetes care 05/2013; 36(10). DOI:10.2337/dc13-0052 · 8.42 Impact Factor
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    ABSTRACT: Aims: Diabetes rates are increasing dramatically, and certain populations are at greater risk. Low income status is associated with higher diabetes prevalence and higher mortality. The effect of income on diabetes incidence is less well understood. Methods: Using a validated, population-based diabetes registry and census data from Ontario, Canada, we compared the rate of new diabetes cases among persons aged 20 years or older between April 1st 2006 and March 31st 2007 between neighborhood income quintiles, and assessed for age- and sex-based differences. Results: There were 88,886 new cases of diabetes in Ontario adults during our study period (incidence rate 8.26/1000, 95% confidence interval, CI 8.20-8.31). Rates increased with age and were higher in males versus females. Increasing income quintile was associated with a significantly decreased diabetes incidence (8.70/1000, 95% CI 8.57-8.82 in the lowest quintile, vs. 7.25/1000, 95% CI 7.14-7.36 in the highest quintile, p<0.0001). Significant interactions were found between income quintile (1, 2, and 3 vs. 5) and age groups (20-39, 40-59 vs. 80+ years) (p<0.01) and sex (p<0.01), such that the impact of income was more pronounced in younger compared to older age groups and in females versus males. Discussion: This population-based study found that diabetes risk is significantly higher in lower compared to higher income groups, and that this income gap was widest in younger persons and females. Greater diabetes preventive efforts directed toward younger and female lower-income populations are necessary, in order to lessen the lifelong burden of diabetes for an already disadvantaged population.
    Diabetes research and clinical practice 01/2013; 99(3). DOI:10.1016/j.diabres.2012.12.005 · 2.54 Impact Factor
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