Fazli Ghazal S, Moineddin Rahim, Chu Anna, Bierman Arlene S, Booth Gillian L
MAP-Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
BMJ Open Diabetes Res Care. 2020 Jun;8(1). doi: 10.1136/bmjdrc-2019-000908.
We examined whether adults living in highly walkable areas are less likely to develop pre-diabetes and if so, whether this association is consistent according to immigration status and ethnicity.
Population-level health, immigration, and administrative databases were used to identify adults aged 20-64 (n=1 128 181) who had normoglycemia between January 2011 and December 2011 and lived in one of 15 cities in Southern Ontario, Canada. Individuals were assigned to one of ten deciles (D) of neighborhood walkability (from lowest (D1) to highest (D10)) and followed until December 2013 for the development of pre-diabetes.
Overall, 220 225 individuals in our sample developed pre-diabetes during a median follow-up of 8.4 years. Pre-diabetes incidence was 20% higher among immigrants living in the least (D1) (adjusted HR 1.20, 95% CI 1.15 to 1.25, p<0.0001) versus most (D10, referent) walkable neighborhoods after accounting for age, sex, and area income. Findings were similar among long-term residents and across sexes. However, susceptibility to walkability varied by ethnicity where D1 versus D10 adjusted HRs ranged from 1.17 (95% CI 1.02 to 1.35, p=0.03) among West Asian and Arab immigrants to 1.32 (95% CI 1.19 to 1.47, p<0.0001) in Southeast Asians. Ethnic variation in pre-diabetes incidence was more marked in low walkability settings. Relative to Western Europeans, the adjusted HR for pre-diabetes incidence was 2.11 (95% CI 1.81 to 2.46, p<0.0001) and 1.50 (95% CI 1.27 to 1.77, p<0.0001) among Sub-Saharan African and the Carribean and Latin American immigrants, respectively, living in the least walkable (D1) neighborhoods, but only 1.24 (95% CI 1.08 to 1.42, p=0.002) and 1.00 (95% CI 0.87 to 1.15, p=0.99) for these same groups living in the most walkable (D10) neighborhoods.
Pre-diabetes incidence was reduced in highly walkable areas for most groups living in Southern Ontario cities. These findings suggest a potential role for walkable urban design in diabetes prevention.
我们研究了生活在步行便利性高的地区的成年人患糖尿病前期的可能性是否较低，如果是，这种关联是否因移民身份和种族而保持一致。
利用人口水平的健康、移民和行政数据库，确定了年龄在20 - 64岁之间（n = 1128181）的成年人，他们在2011年1月至2011年12月期间血糖正常，且居住在加拿大安大略省南部的15个城市之一。个体被分配到邻里步行便利性的十个十分位数（D）之一（从最低（D1）到最高（D10）），并随访至2013年12月，观察糖尿病前期的发生情况。
总体而言，在我们的样本中，220225名个体在中位随访8.4年期间患上了糖尿病前期。在考虑年龄、性别和地区收入后，生活在步行便利性最低（D1）（调整后风险比1.20，95%置信区间1.15至1.25，p < 0.0001）与最高（D10，参照）邻里的移民中，糖尿病前期发病率高出20%。长期居民和不同性别之间的结果相似。然而，对步行便利性的易感性因种族而异，D1与D10的调整后风险比范围从西亚和阿拉伯移民中的1.17（95%置信区间1.02至1.35，p = 0.03）到东南亚移民中的1.32（95%置信区间1.19至1.47，p < 0.0001）。在步行便利性低的环境中，糖尿病前期发病率的种族差异更为明显。相对于西欧人，生活在步行便利性最低（Dl）邻里的撒哈拉以南非洲和加勒比及拉丁美洲移民患糖尿病前期的调整后风险比分别为2.11（95%置信区间1.81至2.46，p < 0.0001）和1.50（95%置信区间1.27至1.77，p < 0.0001），但对于生活在步行便利性最高（D10）邻里的这些相同群体，该风险比仅为1.24（95%置信区间1.08至1.42，p = 0.002）和1.00（95%置信区间0.87至1.15，p = 0.99）。
对于生活在安大略省南部城市的大多数群体，在步行便利性高的地区糖尿病前期发病率降低。这些发现表明适宜步行的城市设计在糖尿病预防中可能发挥作用。
