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
Authors' conclusion
PA 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.
Study context
- Population
- T2D-free veterans (Veterans Administration Diabetes Risk (VADR), electronic health records (EHR), national), REasons for Geographic and Racial Differences in Stroke (REGARDS) national prospective cohort participants, and Geisinger EHR case-control study in Pennsylvaniathree study samples
- Comparison
- Highest vs lowest quartile of neighborhood socioeconomic environment (NSEE), mediated via the leisure-time physical activity (LTPA) environment
- Outcome
- Indirect effects of NSEE on new-onset T2D via PA facility density and population-weighted distance to parks
Methodological detailstwo cohorts and a case-control study, natural direct and indirect effects, stratified by community type, harmonized neighborhood-level variables, VADR: EHR of 4.1 million T2D-free veterans, REGARDS: 11 208 T2D free, Geisinger: 15 888 T2D cases, NSEE measured with a summary index of six census tract indicators
- Two cohorts and a case-control study
- Natural direct and indirect effects
- Stratified by community type
- Harmonized neighborhood-level variables
- VADR: EHR of 4.1 million T2D-free veterans
- REGARDS: 11 208 T2D free
- Geisinger: 15 888 T2D cases
- NSEE measured with a summary index of six census tract indicators
Main finding
As reported in the abstract
Indirect effect via PA facility density in rural communities (difference in T2D incidence rates, highest vs lowest NSEE quartile, ×100)
REGARDS, rural, via physical activity (PA) facility density
1.53
95% CI 0.25, 3.05
VADR, rural, via PA facility density
0.0066
95% CI 0.0038, 0.0099
Observational data: associations, not effects.
Original publication
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 Res Care. Published 1 March 2023. doi:10.
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