Table 4

Total, direct, and indirect effects of higher NSEE (higher socioeconomic disadvantage) on T2D via population-weighted distance to seven nearest parks

NSEE quartilesMediation via population-weighted distance to seven nearest parks (miles)
Total effect (95% CI)Average direct effect (95% CI)Average indirect effect (95% CI)
Higher density urban
VADR cohort (difference in incidence rates)*
 Q2 versus Q10.0018 (0.0013 to 0.0022)0.0018 (0.0013 to 0.0022)0.0001 (−0.0005 to 0.0006)
 Q3 versus Q10.0025 (0.0021 to 0.0030)0.0025 (0.0021 to 0.0030)−0.0002 (−0.0020 to 0.0021)
 Q4 versus Q10.0022 (0.0010 to 0.0031)0.0022 (0.0010 to 0.0031)0.0000 (−0.0015 to 0.0018)
REGARDS cohort (difference in incidence rates)*
 Q2 versus Q14.12 (−0.87 to 9.15)4.00 (−1.11 to 8.95)0.12 (−0.10 to 0.47)
 Q3 versus Q15.78 (0.38 to 11.38)5.77 (0.25 to 11.49)0.01 (−0.25 to 0.30)
 Q4 versus Q13.00 (−2.69 to 8.06)3.08 (−2.65 to 8.23)−0.08 (−0.39 to 0.12)
Geisinger nested case–control (OR)*
 Q2 versus Q11.19 (0.93 to 1.54)1.15 (0.91 to 1.47)1.03 (0.98 to 1.09)
 Q3 versus Q11.11 (0.89 to 1.40)1.11 (0.90 to 1.39)1.00 (0.95 to 1.04)
 Q4 versus Q10.78 (0.56 to 1.09)0.78 (0.57 to 1.08)1.00 (0.93 to 1.07)
Lower density urban
VADR cohort (difference in incidence rates)*
 Q2 versus Q10.0011 (0.0008 to 0.0013)0.0011 (0.0008 to 0.0013)0.0007 (−0.0010 to to 0.0003)
 Q3 versus Q10.0019 (0.0017 to 0.0022)0.0019 (0.0017 to 0.0022)0.0008 (−0.0022 to to 0.0002)
 Q4 versus Q10.0011 (0.0009 to 0.0014)0.0011 (0.0010 to 0.0014)0.0013 (−0.0044 to to 0.0014)
REGARDS cohort (difference in incidence rates)*
 Q2 versus Q11.15 (−2.18 to 4.43)1.19 (−2.13 to 4.50)−0.04 (−0.15 to 0.04)
 Q3 versus Q14.38 (0.59 to 7.93)4.50 (0.80 to 8.01)−0.12 (−0.43 to 0.11)
 Q4 versus Q13.97 (−0.16 to 7.89)4.09 (−0.15 to 8.11)−0.12 (−0.43 to 0.14)
Geisinger nested case control (OR)*
 Q2 versus Q11.55 (1.16 to 2.07)1.53 (1.17 to 2.01)1.01 (0.93 to 1.10)
 Q3 versus Q11.67 (1.26 to 2.23)1.64 (1.25 to 2.14)1.02 (0.94 to 1.12)
 Q4 versus Q11.70 (1.29 to 2.26)1.66 (1.29 to 2.17)1.02 (0.92 to 1.13)
Suburban/small town
VADR cohort (difference in incidence rates)*
 Q2 versus Q10.0013 (0.0010 to 0.0016)0.0013 (0.0010 to 0.0016)0.0002 (0.0000 to 0.0003)
 Q3 versus Q10.0022 (0.0019 to 0.0026)0.0022 (0.0019 to 0.0016)0.0003 (−0.0001 to 0.0008)
 Q4 versus Q10.0026 (0.0019 to 0.0034)0.0026 (0.0019 to 0.0034)−0.0002 (−0.0005 to 0.0001)
REGARDS cohort (difference in incidence rates)*
 Q2 versus Q1−0.77 (−5.07 to 3.65)−0.95 (−5.13 to 3.40)0.18 (−0.18 to 0.59)
 Q3 versus Q11.81 (−2.81 to 6.28)1.48 (−3.21 to 5.86)0.34 (−0.32 to 0.99)
 Q4 versus Q14.04 (−1.36 to 9.64)3.53 (−2.01 to 9.11)0.51 (−0.51 to 1.56)
Geisinger nested case–control (OR)*
 Q2 versus Q11.06 (0.90 to 1.27)1.04 (0.89 to 1.24)1.02 (0.98 to 1.05)
 Q3 versus Q11.15 (0.97 to 1.36)1.16 (0.99 to 1.36)0.99 (0.97 to 1.01)
 Q4 versus Q11.22 (1.02 to 1.45)1.20 (1.01 to 1.43)1.01 (0.97 to 1.05)
Rural
VADR cohort (difference in incidence rates)*
 Q2 versus Q10.0005 (0.0002 to 0.0008)0.0005 (0.0002 to 0.0008)0.0007 (0.0002 to 0.0012)
 Q3 versus Q10.0011 (0.0008 to 0.0014)0.0011 (0.0008 to 0.0014)0.0014 (0.0005 to 0.0022)
 Q4 versus Q10.0017 (0.0014 to 0.0020)0.0016 (0.0014 to 0.0020)0.0015 (0.0000 to 0.0043)
REGARDS cohort (difference in incidence rates)*
 Q2 versus Q15.48 (0.60 to 10.09)6.06 (1.25 to 10.86)−0.58 (−1.37 to 0.10)
 Q3 versus Q13.56 (−1.06 to 7.85)4.38 (−0.32 to 8.91)−0.82 (−1.85 to 0.07)
 Q4 versus Q13.18 (−1.99 to 8.69)4.04 (−1.18 to 9.74)−0.86 (−1.84 to 0.08)
Geisinger nested case–control (OR)*
 Q2 versus Q11.04 (0.94 to 1.15)1.02 (0.92 to 1.14)1.02 (0.99 to 1.05)
 Q3 versus Q11.15 (1.06 to 1.26)1.12 (1.02 to 1.23)1.03 (0.99 to 1.07)
 Q4 versus Q11.17 (1.06 to 1.31)1.14 (1.03 to 1.28)1.03 (0.99 to 1.07)
  • Bolded values indicate statistically significant (p<0.05).

  • *For the cohort studies (VADR and REGARDS), mediation effects are presented as differences in incidence rates and rescaled by multiplying by 100 for interpretability. For the case–control study (Geisinger EHR), mediation effects are presented as ORs.

  • EHR, electronic health record; NSEE, neighborhood socioeconomic environment; PA, physical activity; Q, quartile; REGARDS, REasons for Geographic and Racial Differences in Stroke; T2D, type 2 diabetes; VADR, Veterans Administration Diabetes Risk.