Amsterdam University Medical Centers, Amsterdam, the Netherlands.
Upstream Team, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Diabetes Care. 2023 Jun 1;46(6):1177-1184. doi: 10.2337/dc22-1549.
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.
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.
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).
High neighborhood drivability is a risk factor for diabetes, particularly in younger adults. This finding has important implications for future urban design policies.
汽车依赖会导致身体活动不足，从而增加患糖尿病的可能性。我们研究了高度有利于驾驶的社区是否会增加患糖尿病的风险，如果是，这种情况是否因年龄而异。
我们使用行政医疗保健数据来识别所有居住在多伦多的 20-64 岁的加拿大成年工作者（20-64 岁），他们在 2021 年 4 月 1 日没有患糖尿病（1 型或 2 型）。使用一种新的、经过验证的指数来分配邻里驾驶能力评分，该指数基于基于建筑环境特征的驾驶模式预测，分为五分位数。使用 Cox 回归来检查邻里驾驶能力与 7 年糖尿病发病风险之间的关联，总体上和按年龄组进行检查，并根据基线特征和合并症进行调整。
总体而言，队列中有 1473994 名成年人（平均年龄 40.9 ± 12.2 岁），其中 77835 人在随访期间患上了糖尿病。与居住在最适合驾驶的社区（五分位数 5）的人相比，居住在最不适合驾驶的社区（五分位数 1）的人患糖尿病的风险高出 41%（调整后的危险比 1.41，95%CI 1.37-1.44），在 20-34 岁的年轻成年人中关联最强（1.57，95%CI 1.47-1.68，P < 0.001 用于交互）。在年龄较大的成年人（55-64 岁）中，差异较小（1.31，95%CI 1.26-1.36）。对于年轻居民（中等收入 1.96，95%CI 1.64-2.33）和老年居民（1.46，95%CI 1.32-1.62），这种关联在中等收入社区中似乎最强。
高邻里驾驶能力是糖尿病的一个危险因素，尤其是在年轻成年人中。这一发现对未来的城市设计政策具有重要意义。
