TY - JOUR
T1 - Impact of land use and food environment on risk of type 2 diabetes
T2 - A national study of veterans, 2008–2018
AU - India-Aldana, Sandra
AU - Kanchi, Rania
AU - Adhikari, Samrachana
AU - Lopez, Priscilla
AU - Schwartz, Mark D.
AU - Elbel, Brian D.
AU - Rummo, Pasquale E.
AU - Meeker, Melissa A.
AU - Lovasi, Gina S.
AU - Siegel, Karen R.
AU - Chen, Yu
AU - Thorpe, Lorna E.
N1 - Funding Information:
This research was conducted by the Diabetes LEAD Network, funded through CDC cooperative agreements U01DP006293(Drexel University), U01DP006296(Geisinger-Johns Hopkins University), U01DP006299(New York University School of Medicine), and U01DP006302(University of Alabama at Birmingham), in collaboration with the U.S. Centers for Disease Control and Prevention, Division of Diabetes Translation. The Retail Environment and Cardiovascular Disease (RECVD) study was supported by the National Institute of Aging (grants 1R01AG049970, 3R01AG049970-04S1), Commonwealth Universal Research Enhancement (C.U.R.E) program funded by the Pennsylvania Department of Health - 2015 Formula award - SAP #4100072543, the Urban Health Collaborative at Drexel University, and the Built Environment and Health Research Group at Columbia University.
Funding Information:
This research was conducted by the Diabetes LEAD Network, funded through CDC cooperative agreements U01DP006293 ( Drexel University ), U01DP006296 (Geisinger- Johns Hopkins University ), U01DP006299 ( New York University School of Medicine ), and U01DP006302 ( University of Alabama at Birmingham ), in collaboration with the U.S. Centers for Disease Control and Prevention , Division of Diabetes Translation. The Retail Environment and Cardiovascular Disease (RECVD) study was supported by the National Institute of Aging (grants 1R01AG049970 , 3R01AG049970-04S1 ), Commonwealth Universal Research Enhancement (C.U.R.E) program funded by the Pennsylvania Department of Health - 2015 Formula award - SAP #4100072543 , the Urban Health Collaborative at Drexel University , and the Built Environment and Health Research Group at Columbia University .
Publisher Copyright:
© 2022 The Authors
PY - 2022/9
Y1 - 2022/9
N2 - Background: Large-scale longitudinal studies evaluating influences of the built environment on risk for type 2 diabetes (T2D) are scarce, and findings have been inconsistent. Objective: To evaluate whether land use environment (LUE), a proxy of neighborhood walkability, is associated with T2D risk across different US community types, and to assess whether the association is modified by food environment. Methods: The Veteran's Administration Diabetes Risk (VADR) study is a retrospective cohort of diabetes-free US veteran patients enrolled in VA primary care facilities nationwide from January 1, 2008, to December 31, 2016, and followed longitudinally through December 31, 2018. A total of 4,096,629 patients had baseline addresses available in electronic health records that were geocoded and assigned a census tract-level LUE score. LUE scores were divided into quartiles, where a higher score indicated higher neighborhood walkability levels. New diagnoses for T2D were identified using a published computable phenotype. Adjusted time-to-event analyses using piecewise exponential models were fit within four strata of community types (higher-density urban, lower-density urban, suburban/small town, and rural). We also evaluated effect modification by tract-level food environment measures within each stratum. Results: In adjusted analyses, higher LUE had a protective effect on T2D risk in rural and suburban/small town communities (linear quartile trend test p-value <0.001). However, in lower density urban communities, higher LUE increased T2D risk (linear quartile trend test p-value <0.001) and no association was found in higher density urban communities (linear quartile trend test p-value = 0.317). Particularly strong protective effects were observed for veterans living in suburban/small towns with more supermarkets and more walkable spaces (p-interaction = 0.001). Conclusion: Among veterans, LUE may influence T2D risk, particularly in rural and suburban communities. Food environment may modify the association between LUE and T2D.
AB - Background: Large-scale longitudinal studies evaluating influences of the built environment on risk for type 2 diabetes (T2D) are scarce, and findings have been inconsistent. Objective: To evaluate whether land use environment (LUE), a proxy of neighborhood walkability, is associated with T2D risk across different US community types, and to assess whether the association is modified by food environment. Methods: The Veteran's Administration Diabetes Risk (VADR) study is a retrospective cohort of diabetes-free US veteran patients enrolled in VA primary care facilities nationwide from January 1, 2008, to December 31, 2016, and followed longitudinally through December 31, 2018. A total of 4,096,629 patients had baseline addresses available in electronic health records that were geocoded and assigned a census tract-level LUE score. LUE scores were divided into quartiles, where a higher score indicated higher neighborhood walkability levels. New diagnoses for T2D were identified using a published computable phenotype. Adjusted time-to-event analyses using piecewise exponential models were fit within four strata of community types (higher-density urban, lower-density urban, suburban/small town, and rural). We also evaluated effect modification by tract-level food environment measures within each stratum. Results: In adjusted analyses, higher LUE had a protective effect on T2D risk in rural and suburban/small town communities (linear quartile trend test p-value <0.001). However, in lower density urban communities, higher LUE increased T2D risk (linear quartile trend test p-value <0.001) and no association was found in higher density urban communities (linear quartile trend test p-value = 0.317). Particularly strong protective effects were observed for veterans living in suburban/small towns with more supermarkets and more walkable spaces (p-interaction = 0.001). Conclusion: Among veterans, LUE may influence T2D risk, particularly in rural and suburban communities. Food environment may modify the association between LUE and T2D.
KW - Food environment
KW - Land use environment
KW - Type 2 diabetes
KW - Veterans
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U2 - 10.1016/j.envres.2022.113146
DO - 10.1016/j.envres.2022.113146
M3 - Article
C2 - 35337829
AN - SCOPUS:85127142222
SN - 0013-9351
VL - 212
JO - Environmental Research
JF - Environmental Research
M1 - 113146
ER -