Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Warrnambool, Victoria, Australia; Geohealth Laboratory, Dasman Diabetes Institute, Kuwait City, 15462, Kuwait.
Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Warrnambool, Victoria, Australia.
Soc Sci Med. 2024 Nov;361:117372. doi: 10.1016/j.socscimed.2024.117372. Epub 2024 Sep 30.
This study aimed to systematically review longitudinal studies examining associations between the incidence of type 2 diabetes mellitus (T2DM) and built environmental factors. This review adhered to the 2020 PRISMA guidelines. Longitudinal studies examining associations between T2DM incidence and built environmental features were eligible. Built environment constructs corresponded to the following themes: 1) Walkability - factors such as sidewalks/footpaths, crosswalks, parks, and density of businesses and services; (2) Green/open space - size, greenness, and type of available public outdoor spaces; (3) Food environment - ratio of healthful food outlets (e.g., greengrocers, butchers, supermarkets, and health food shops) to unhealthful food outlets (e.g., fast-food outlets, sweet food retailers, and convenience stores). Five databases (e.g., Medline) were searched from inception until July 2023. Qualitative and quantitative synthesis were used to summarise key findings, including a meta-analysis of adjusted Hazard Ratios (aHR). Of 3,343 articles, 16 longitudinal studies from seven countries, published between 2015 and 2023, involving 13,403,902 baseline participants (median of 83,898), were included. In four of the five studies, unhealthful food environment was significantly associated with higher incident T2DM. Five of seven greenspace studies and two of four walkability studies showed that greater greenery and greater walkability were statistically significantly associated with lesser incident T2DM. In pooled analyses, greater T2DM incidence was associated with unhealthful relative to healthful food environments (pooled HR: 1.21; 95% CI: 1.04, 1.42), and T2DM incidence was inversely associated with green/open space environments (pooled HR: 0.82; 95% CI: 0.74, 0.92). Greater walkability was associated with a slight 2% lesser incidence of T2DM (pooled HR: 0.98; 95% CI: 0.98, 0.99). This review underscores consistency in the nature of associations between built environment features related to T2DM. We observed statistically significant inverse or "protective" associations between T2DM and walkability and healthful food environments. These results support calls for policies and guidelines that promote healthful food environments and walkability.
本研究旨在系统综述观察 2 型糖尿病（T2DM）发病率与建筑环境因素之间关联的纵向研究。本综述遵循 2020 年 PRISMA 指南。纳入观察 T2DM 发病率与建筑环境特征之间关联的纵向研究。建筑环境结构与以下主题相对应：1）可步行性- 人行道/小路、人行横道、公园以及商业和服务设施密度等因素；（2）绿色/开放空间- 公共户外空间的大小、绿化程度和类型；（3）食品环境- 健康食品（如蔬菜店、肉店、超市和保健食品店）与不健康食品（如快餐店、甜食零售商和便利店）的比例。从创建到 2023 年 7 月，从 5 个数据库（如 Medline）中检索了文献。使用定性和定量综合方法总结关键发现，包括调整后的危险比（aHR）的荟萃分析。在 3343 篇文章中，纳入了来自 7 个国家的 16 项纵向研究，发表于 2015 年至 2023 年之间，涉及 13403902 名基线参与者（中位数为 83898 人）。在五项研究中的四项中，不健康的食品环境与更高的 T2DM 发生率显著相关。七项绿地研究中的五项和四项可步行性研究中的两项表明，更多的绿化和更高的可步行性与较低的 T2DM 发生率具有统计学显著相关性。在汇总分析中，与健康食品环境相比，不健康的食品环境与更高的 T2DM 发生率相关（汇总 HR：1.21；95%CI：1.04，1.42），而 T2DM 发生率与绿地/开放空间环境呈负相关（汇总 HR：0.82；95%CI：0.74，0.92）。更高的可步行性与 T2DM 发生率略有降低 2%相关（汇总 HR：0.98；95%CI：0.98，0.99）。本综述强调了与 T2DM 相关的建筑环境特征之间关联的本质一致性。我们观察到 T2DM 与可步行性和健康食品环境之间存在统计学显著的反向或“保护”关联。这些结果支持呼吁制定促进健康食品环境和可步行性的政策和指导方针。
