Total, direct, and indirect effects of higher NSEE (higher socioeconomic disadvantage) on T2D via PA facility density within street network buffers
| NSEE quartiles | Mediation via PA facility density (count/km2) | ||
| Total effect (95% CI) | Average direct effect (95% CI) | Average indirect effect (95% CI) | |
| Higher density urban (1-mile walking buffer) | |||
| VADR cohort (difference in incidence rates)* | |||
| Q2 versus Q1 | 0.0017 (0.0009 to 0.0024) | 0.0018 (0.0010 to 0.0026) | −0.0111 (−0.0165 to 0.0055) |
| Q3 versus Q1 | 0.0023 (0.0015 to 0.0030) | 0.0025 (0.0017 to 0.0032) | −0.0177 (−0.0247 to 0.0105) |
| Q4 versus Q1 | 0.0024 (0.0015 to 0.0035) | 0.0025 (0.0016 to 0.0036) | −0.0117 (−0.0165 to 0.0055) |
| REGARDS cohort (difference in incidence rates)* | |||
| Q2 versus Q1 | 4.15 (−1.06 to 9.24) | 4.24 (−0.96 to 9.41) | −0.10 (−0.67 to 0.40) |
| Q3 versus Q1 | 5.76 (0.25 to 11.05) | 5.78 (0.27 to 10.94) | −0.02 (−0.35 to 0.25) |
| Q4 versus Q1 | 3.17 (−2.36 to 8.55) | 3.26 (−2.25 to 8.71) | −0.09 (−0.65 to 0.41) |
| Geisinger nested case–control (OR)* | |||
| Q2 versus Q1 | 1.19 (0.94 to 1.53) | 1.14 (0.90 to 1.47) | 1.04 (0.97 to 1.13) |
| Q3 versus Q1 | 1.11 (0.88 to 1.41) | 1.08 (0.86 to 1.37) | 1.03 (0.95 to 1.11) |
| Q4 versus Q1 | 0.78 (0.56 to 1.11) | 0.80 (0.59 to 1.09) | 0.97 (0.87 to 1.08) |
| Lower density urban (2-mile driving buffer) | |||
| VADR cohort (difference in incidence rates)* | |||
| Q2 versus Q1 | 0.0010 (0.0007 to 0.0012) | 0.0010 (0.0007 to 0.0012) | 0.0017 (0.0013 to 0.0023) |
| Q3 versus Q1 | 0.0019 (0.0002 to 0.0022) | 0.0019 (0.0016 to 0.0022) | 0.0010 (0.0008 to 0.0011) |
| Q4 versus Q1 | 0.0012 (0.0008 to 0.0015) | 0.0012 (0.0009 to 0.0015) | −0.0012 (−0.0015 to 0.0008) |
| REGARDS cohort (difference in incidence rates)* | |||
| Q2 versus Q1 | 0.92 (−2.61 to 4.07) | 0.90 (−2.62 to 4.09) | 0.01 (−0.06 to 0.12) |
| Q3 versus Q1 | 4.40 (0.49 to 7.82) | 4.45 (0.49 to 7.82) | −0.05 (−0.27 to 0.15) |
| Q4 versus Q1 | 3.94 (−0.47 to 7.98) | 4.00 (−0.39 to 8.18) | −0.07 (−0.06 to 0.12) |
| Geisinger nested case–control (OR)* | |||
| Q2 versus Q1 | 1.55 (1.16 to 2.05) | 1.55 (1.17 to 2.04) | 1.00 (0.95 to 1.05) |
| Q3 versus Q1 | 1.67 (1.26 to 2.23) | 1.68 (1.26 to 2.23) | 1.01 (0.97 to 1.06) |
| Q4 versus Q1 | 1.70 (1.29 to 2.30) | 1.68 (1.27 to 2.26) | 1.01 (0.97 to 1.06) |
| Suburban/small town (6-mile driving buffer) | |||
| VADR cohort (difference in incidence rates)* | |||
| Q2 versus Q1 | 0.0013 (0.0009 to 0.0017) | 0.0013 (0.0009 to 0.0017) | −0.0035 (0.0058 to 0.0006) |
| Q3 versus Q1 | 0.0023 (0.0020 to 0.0028) | 0.0024 (0.0021 to 0.0029) | −0.0085 (−0.0147 to 0.0039) |
| Q4 versus Q1 | 0.0028 (0.0023 to 0.0032) | 0.0030 (0.0024 to 0.0033) | −0.0109 (−0.0157 to 0.0050) |
| REGARDS cohort (difference in incidence rates)* | |||
| Q2 versus Q1 | −0.31 (−4.81 to 3.97) | −1.21 (−5.77 to 3.05) | 0.90 (0.04 to 1.99) |
| Q3 versus Q1 | 2.33 (−2.53 to 6.68) | 0.77 (−4.37 to 5.39) | 1.55 (−0.001 to 3.27) |
| Q4 versus Q1 | 4.97 (−0.64 to 10.89) | 2.69 (−3.33 to 8.74) | 2.28 (−0.09 to 4.73) |
| Geisinger nested case–control (OR)* | |||
| Q2 versus Q1 | 1.06 (0.90 to 1.26) | 1.05 (0.91 to 1.23) | 1.01 (0.97 to 1.04) |
| Q3 versus Q1 | 1.15 (0.98 to 1.35) | 1.17 (0.99 to 1.38) | 0.99 (0.95 to 1.02) |
| Q4 versus Q1 | 1.22 (1.02 to 1.45) | 1.23 (1.03 to 1.47) | 0.99 (0.95 to 1.03) |
| Rural (6-mile driving buffer) | |||
| VADR cohort (difference in incidence rates)* | |||
| Q2 versus Q1 | 0.0007 (0.0003 to 0.0011) | 0.0006 (0.0002 to 0.0011) | 0.0025 (0.0011 to 0.0034) |
| Q3 versus Q1 | 0.0011 (0.0008 to 0.0015) | 0.0011 (0.0002 to 0.0011) | 0.0048 (0.0028 to 0.0075) |
| Q4 versus Q1 | 0.0020 (0.0019 to 0.0023) | 0.0020 (0.0018 to 0.0022) | 0.0066 (0.0038 to 0.0099) |
| REGARDS cohort (difference in incidence rates)* | |||
| Q2 versus Q1 | 5.63 (0.91 to 10.59) | 4.69 (0.15 to 9.49) | 0.94 (0.18 to 1.90) |
| Q3 versus Q1 | 3.55 (−1.11 to 8.25) | 2.31 (−2.55 to 7.14) | 1.24 (0.16 to 2.39) |
| Q4 versus Q1 | 3.00 (−2.24 to 8.21) | 1.48 (−4.35 to 6.67) | 1.53 (0.25 to 3.05) |
| Geisinger nested case–control (OR)* | |||
| Q2 versus Q1 | 1.04 (0.93 to 1.16) | 1.04 (0.92 to 1.16) | 1.00 (0.99 to 1.02) |
| Q3 versus Q1 | 1.15 (1.06 to 1.26) | 1.15 (1.05 to 1.26) | 1.00 (0.99 to 1.02) |
| Q4 versus Q1 | 1.17 (1.06 to 1.32) | 1.17 (1.05 to 1.32) | 1.00 (0.99 to 1.02) |
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.