NSEE quartiles | Mediation 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 Q1 | 0.0018 (0.0013 to 0.0022) | 0.0018 (0.0013 to 0.0022) | 0.0001 (−0.0005 to 0.0006) |
Q3 versus Q1 | 0.0025 (0.0021 to 0.0030) | 0.0025 (0.0021 to 0.0030) | −0.0002 (−0.0020 to 0.0021) |
Q4 versus Q1 | 0.0022 (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 Q1 | 4.12 (−0.87 to 9.15) | 4.00 (−1.11 to 8.95) | 0.12 (−0.10 to 0.47) |
Q3 versus Q1 | 5.78 (0.38 to 11.38) | 5.77 (0.25 to 11.49) | 0.01 (−0.25 to 0.30) |
Q4 versus Q1 | 3.00 (−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 Q1 | 1.19 (0.93 to 1.54) | 1.15 (0.91 to 1.47) | 1.03 (0.98 to 1.09) |
Q3 versus Q1 | 1.11 (0.89 to 1.40) | 1.11 (0.90 to 1.39) | 1.00 (0.95 to 1.04) |
Q4 versus Q1 | 0.78 (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 Q1 | 0.0011 (0.0008 to 0.0013) | 0.0011 (0.0008 to 0.0013) | −0.0007 (−0.0010 to to 0.0003) |
Q3 versus Q1 | 0.0019 (0.0017 to 0.0022) | 0.0019 (0.0017 to 0.0022) | −0.0008 (−0.0022 to to 0.0002) |
Q4 versus Q1 | 0.0011 (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 Q1 | 1.15 (−2.18 to 4.43) | 1.19 (−2.13 to 4.50) | −0.04 (−0.15 to 0.04) |
Q3 versus Q1 | 4.38 (0.59 to 7.93) | 4.50 (0.80 to 8.01) | −0.12 (−0.43 to 0.11) |
Q4 versus Q1 | 3.97 (−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 Q1 | 1.55 (1.16 to 2.07) | 1.53 (1.17 to 2.01) | 1.01 (0.93 to 1.10) |
Q3 versus Q1 | 1.67 (1.26 to 2.23) | 1.64 (1.25 to 2.14) | 1.02 (0.94 to 1.12) |
Q4 versus Q1 | 1.70 (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 Q1 | 0.0013 (0.0010 to 0.0016) | 0.0013 (0.0010 to 0.0016) | 0.0002 (0.0000 to 0.0003) |
Q3 versus Q1 | 0.0022 (0.0019 to 0.0026) | 0.0022 (0.0019 to 0.0016) | 0.0003 (−0.0001 to 0.0008) |
Q4 versus Q1 | 0.0026 (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 Q1 | 1.81 (−2.81 to 6.28) | 1.48 (−3.21 to 5.86) | 0.34 (−0.32 to 0.99) |
Q4 versus Q1 | 4.04 (−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 Q1 | 1.06 (0.90 to 1.27) | 1.04 (0.89 to 1.24) | 1.02 (0.98 to 1.05) |
Q3 versus Q1 | 1.15 (0.97 to 1.36) | 1.16 (0.99 to 1.36) | 0.99 (0.97 to 1.01) |
Q4 versus Q1 | 1.22 (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 Q1 | 0.0005 (0.0002 to 0.0008) | 0.0005 (0.0002 to 0.0008) | 0.0007 (0.0002 to 0.0012) |
Q3 versus Q1 | 0.0011 (0.0008 to 0.0014) | 0.0011 (0.0008 to 0.0014) | 0.0014 (0.0005 to 0.0022) |
Q4 versus Q1 | 0.0017 (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 Q1 | 5.48 (0.60 to 10.09) | 6.06 (1.25 to 10.86) | −0.58 (−1.37 to 0.10) |
Q3 versus Q1 | 3.56 (−1.06 to 7.85) | 4.38 (−0.32 to 8.91) | −0.82 (−1.85 to 0.07) |
Q4 versus Q1 | 3.18 (−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 Q1 | 1.04 (0.94 to 1.15) | 1.02 (0.92 to 1.14) | 1.02 (0.99 to 1.05) |
Q3 versus Q1 | 1.15 (1.06 to 1.26) | 1.12 (1.02 to 1.23) | 1.03 (0.99 to 1.07) |
Q4 versus Q1 | 1.17 (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.