RT Journal Article
SR Electronic
T1 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
JF BMJ Open Diabetes Research & Care
JO BMJ Open Diab Res Care
FD American Diabetes Association
SP e003120
DO 10.1136/bmjdrc-2022-003120
VO 11
IS 2
A1 Katherine A Moon
A1 Cara M Nordberg
A1 Stephanie L Orstad
A1 Aowen Zhu
A1 Jalal Uddin
A1 Priscilla Lopez
A1 Mark D Schwartz
A1 Victoria Ryan
A1 Annemarie G Hirsch
A1 Brian S Schwartz
A1 April P Carson
A1 D Leann Long
A1 Melissa Meeker
A1 Janene Brown
A1 Gina S Lovasi
A1 Samranchana Adhikari
A1 Rania Kanchi
A1 Sanja Avramovic
A1 Giuseppina Imperatore
A1 Melissa N Poulsen
YR 2023
UL http://drc.bmj.com/content/11/2/e003120.abstract
AB Introduction Inequitable access to leisure-time physical activity (LTPA) resources may explain geographic disparities in type 2 diabetes (T2D). We evaluated whether the neighborhood socioeconomic environment (NSEE) affects T2D through the LTPA environment.Research design and methods We conducted analyses in three study samples: the national Veterans Administration Diabetes Risk (VADR) cohort comprising electronic health records (EHR) of 4.1 million T2D-free veterans, the national prospective cohort REasons for Geographic and Racial Differences in Stroke (REGARDS) (11 208 T2D free), and a case–control study of Geisinger EHR in Pennsylvania (15 888 T2D cases). New-onset T2D was defined using diagnoses, laboratory and medication data. We harmonized neighborhood-level variables, including exposure, confounders, and effect modifiers. We measured NSEE with a summary index of six census tract indicators. The LTPA environment was measured by physical activity (PA) facility (gyms and other commercial facilities) density within street network buffers and population-weighted distance to parks. We estimated natural direct and indirect effects for each mediator stratified by community type.Results The magnitudes of the indirect effects were generally small, and the direction of the indirect effects differed by community type and study sample. The most consistent findings were for mediation via PA facility density in rural communities, where we observed positive indirect effects (differences in T2D incidence rates (95% CI) comparing the highest versus lowest quartiles of NSEE, multiplied by 100) of 1.53 (0.25, 3.05) in REGARDS and 0.0066 (0.0038, 0.0099) in VADR. No mediation was evident in Geisinger.Conclusions 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.Data are available on reasonable request. Data are available on reasonable request. Deidentified data are available on request with IRB approval and a data use agreement.