Artikel
Walkability and its association with prevalent and incident diabetes among adults in different regions of Germany: results of pooled data from five German cohorts
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Autoren
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Nadja Kartschmit
- Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany; Deutsches Zentrum für Diabetesforschung (DZD), Neuherberg, Germany
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Robynne Sutcliffe
- Universitätsklinikum Essen, Essen, Germany
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Mark Patrick Sheldon
- University of Birmingham, Birmingham, United Kingdom
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Susanne Moebus
- Universitätsklinikum Essen, Essen, Germany
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Karin Halina Greiser
- Deutsches Krebsforschungszentrum Heidelberg, Heidelberg, Germany; Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany
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Saskia Hartwig
- Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany; Deutsches Zentrum für Diabetesforschung (DZD), Neuherberg, Germany
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Detlef Thürkow
- Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany
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Ulrike Stentzel
- Universitätsmedizin Greifswald, Greifswald, Germany
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Neeltje van den Berg
- Universitätsmedizin Greifswald, Greifswald, Germany
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Kathrin Wolf
- Helmholtz Zentrum München, Neuherberg, Germany; Deutsches Zentrum für Diabetesforschung (DZD), Neuherberg, Germany
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Werner Maier
- Helmholtz Zentrum München, Neuherberg, Germany; Deutsches Zentrum für Diabetesforschung (DZD), Neuherberg, Germany
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Annette Peters
- Helmholtz Zentrum München, Neuherberg, Germany; Deutsches Zentrum für Diabetesforschung (DZD), Neuherberg, Germany
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Salman Ahmed
- Universitätsklinikum Essen, Essen, Germany
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Corinna Rahe
- Universität Münster, Münster, Germany
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Rafael Mikolajczyk
- Martin-Luther-Universität Halle-Wittenberg, Halle(Saale), Germany
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Andreas Wienke
- Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
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Alexander Kluttig
- Martin-Luther-Universität Halle-Wittenberg, Halle, Germany; Deutsches Zentrum für Diabetesforschung (DZD), Neuherberg, Germany
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Gavin Rudge
- University of Birmingham, Birmingham, United Kingdom
| Veröffentlicht: | 6. September 2019 |
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Gliederung
Text
Background and aim: Walkable neighbourhoods, characterized by high land-use mix and street connectivity, may increase physical activity and hence decrease the risk for type 2 diabetes (T2D). We aimed to investigate the association between walkability and prevalent and incident T2D in a pooled sample from five German cohorts in different regions of the country (city of Halle (CARLA), Western Pomerania (SHIP), cities of Ruhr Area (Heinz Nixdorf Recall), Augsburg and environs (KORA), and city of Dortmund (DO-GS)).
Methods: ArcGIS Geoinformation System in ESRI version 10.1 and 10.4 and OpenStreetMap data of 2016 were used to derive three walkability measures. The following measures were assigned to participants' addresses: number of transit stations, points of interest (POI, including cash machines, bank, bar, beer gardens, cafés, fast food restaurants, pharmacies, pubs, restaurants, and post offices), and impedance (restrictions to walking, e.g. due to physical barriers such as rivers or the absence of intersections and pathways) within a radius of 640 meters. We chose 640 m because of research showing that the propensity to walk to access public transport decreases after 640 meters.
We estimated associations between walkability and prevalent and incident T2D with modified Poisson regressions and adjusted for education, sex, body mass index at baseline, age at baseline, and cohort.
Results and Discussion: Of the baseline 15,936 participants, 1,252 participants had prevalent T2D. Participants free from T2D at baseline were followed over a mean of 9.1 years (SD: 3.5, minimum: 1.6, maximum: 14.8 years). Of these, 1,024 participants developed T2D. Overall, we found no associations between walkability measures and prevalent and incident T2D with all estimates close to one (e.g. Relative Risk (RR) per one standard deviation (SD) for impedance and prevalent T2D: 1.01, 95 % Confidence Interval (CI): 0.98, 1.04). Surprisingly, we have found an association of higher number of POI and prevalent T2D (RR per one SD: 1.07, 95% CI: 1.02, 1.13). However, the variety of POI was not explicitly taken into account and (fast food) restaurants were included as POI, which may explain this finding. On the whole, the effect of relatively homogeneous walkability in our population might not be strong enough to find an effect on T2D.
The authors declare that they have no competing interests.
The authors declare that a positive ethics committee vote has been obtained.
