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Mediation of an association between neighborhood socioeconomic environment and type 2 diabetes through the leisure-time physical activity environment in an analysis of three independent samples

INTRODUCTION: Inequitable access to leisure-time physical activity (LTPA) resources may explain geographic disparities in type 2 diabetes (T2D). We evaluated whether the neighborhood socioeconomic environment (NSEE) affects T2D through the LTPA environment. RESEARCH DESIGN AND METHODS: We conducted...

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Autores principales: Moon, Katherine A, Nordberg, Cara M, Orstad, Stephanie L, Zhu, Aowen, Uddin, Jalal, Lopez, Priscilla, Schwartz, Mark D, Ryan, Victoria, Hirsch, Annemarie G, Schwartz, Brian S, Carson, April P, Long, D Leann, Meeker, Melissa, Brown, Janene, Lovasi, Gina S, Adhikari, Samranchana, Kanchi, Rania, Avramovic, Sanja, Imperatore, Giuseppina, Poulsen, Melissa N
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9980357/
https://www.ncbi.nlm.nih.gov/pubmed/36858436
http://dx.doi.org/10.1136/bmjdrc-2022-003120
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author Moon, Katherine A
Nordberg, Cara M
Orstad, Stephanie L
Zhu, Aowen
Uddin, Jalal
Lopez, Priscilla
Schwartz, Mark D
Ryan, Victoria
Hirsch, Annemarie G
Schwartz, Brian S
Carson, April P
Long, D Leann
Meeker, Melissa
Brown, Janene
Lovasi, Gina S
Adhikari, Samranchana
Kanchi, Rania
Avramovic, Sanja
Imperatore, Giuseppina
Poulsen, Melissa N
author_facet Moon, Katherine A
Nordberg, Cara M
Orstad, Stephanie L
Zhu, Aowen
Uddin, Jalal
Lopez, Priscilla
Schwartz, Mark D
Ryan, Victoria
Hirsch, Annemarie G
Schwartz, Brian S
Carson, April P
Long, D Leann
Meeker, Melissa
Brown, Janene
Lovasi, Gina S
Adhikari, Samranchana
Kanchi, Rania
Avramovic, Sanja
Imperatore, Giuseppina
Poulsen, Melissa N
author_sort Moon, Katherine A
collection PubMed
description INTRODUCTION: Inequitable access to leisure-time physical activity (LTPA) resources may explain geographic disparities in type 2 diabetes (T2D). We evaluated whether the neighborhood socioeconomic environment (NSEE) affects T2D through the LTPA environment. RESEARCH DESIGN AND METHODS: We conducted analyses in three study samples: the national Veterans Administration Diabetes Risk (VADR) cohort comprising electronic health records (EHR) of 4.1 million T2D-free veterans, the national prospective cohort REasons for Geographic and Racial Differences in Stroke (REGARDS) (11 208 T2D free), and a case–control study of Geisinger EHR in Pennsylvania (15 888 T2D cases). New-onset T2D was defined using diagnoses, laboratory and medication data. We harmonized neighborhood-level variables, including exposure, confounders, and effect modifiers. We measured NSEE with a summary index of six census tract indicators. The LTPA environment was measured by physical activity (PA) facility (gyms and other commercial facilities) density within street network buffers and population-weighted distance to parks. We estimated natural direct and indirect effects for each mediator stratified by community type. RESULTS: The magnitudes of the indirect effects were generally small, and the direction of the indirect effects differed by community type and study sample. The most consistent findings were for mediation via PA facility density in rural communities, where we observed positive indirect effects (differences in T2D incidence rates (95% CI) comparing the highest versus lowest quartiles of NSEE, multiplied by 100) of 1.53 (0.25, 3.05) in REGARDS and 0.0066 (0.0038, 0.0099) in VADR. No mediation was evident in Geisinger. CONCLUSIONS: PA facility density and distance to parks did not substantially mediate the relation between NSEE and T2D. Our heterogeneous results suggest that approaches to reduce T2D through changes to the LTPA environment require local tailoring.
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spelling pubmed-99803572023-03-03 Mediation of an association between neighborhood socioeconomic environment and type 2 diabetes through the leisure-time physical activity environment in an analysis of three independent samples Moon, Katherine A Nordberg, Cara M Orstad, Stephanie L Zhu, Aowen Uddin, Jalal Lopez, Priscilla Schwartz, Mark D Ryan, Victoria Hirsch, Annemarie G Schwartz, Brian S Carson, April P Long, D Leann Meeker, Melissa Brown, Janene Lovasi, Gina S Adhikari, Samranchana Kanchi, Rania Avramovic, Sanja Imperatore, Giuseppina Poulsen, Melissa N BMJ Open Diabetes Res Care Epidemiology/Health services research INTRODUCTION: Inequitable access to leisure-time physical activity (LTPA) resources may explain geographic disparities in type 2 diabetes (T2D). We evaluated whether the neighborhood socioeconomic environment (NSEE) affects T2D through the LTPA environment. RESEARCH DESIGN AND METHODS: We conducted analyses in three study samples: the national Veterans Administration Diabetes Risk (VADR) cohort comprising electronic health records (EHR) of 4.1 million T2D-free veterans, the national prospective cohort REasons for Geographic and Racial Differences in Stroke (REGARDS) (11 208 T2D free), and a case–control study of Geisinger EHR in Pennsylvania (15 888 T2D cases). New-onset T2D was defined using diagnoses, laboratory and medication data. We harmonized neighborhood-level variables, including exposure, confounders, and effect modifiers. We measured NSEE with a summary index of six census tract indicators. The LTPA environment was measured by physical activity (PA) facility (gyms and other commercial facilities) density within street network buffers and population-weighted distance to parks. We estimated natural direct and indirect effects for each mediator stratified by community type. RESULTS: The magnitudes of the indirect effects were generally small, and the direction of the indirect effects differed by community type and study sample. The most consistent findings were for mediation via PA facility density in rural communities, where we observed positive indirect effects (differences in T2D incidence rates (95% CI) comparing the highest versus lowest quartiles of NSEE, multiplied by 100) of 1.53 (0.25, 3.05) in REGARDS and 0.0066 (0.0038, 0.0099) in VADR. No mediation was evident in Geisinger. CONCLUSIONS: PA facility density and distance to parks did not substantially mediate the relation between NSEE and T2D. Our heterogeneous results suggest that approaches to reduce T2D through changes to the LTPA environment require local tailoring. BMJ Publishing Group 2023-03-01 /pmc/articles/PMC9980357/ /pubmed/36858436 http://dx.doi.org/10.1136/bmjdrc-2022-003120 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Epidemiology/Health services research
Moon, Katherine A
Nordberg, Cara M
Orstad, Stephanie L
Zhu, Aowen
Uddin, Jalal
Lopez, Priscilla
Schwartz, Mark D
Ryan, Victoria
Hirsch, Annemarie G
Schwartz, Brian S
Carson, April P
Long, D Leann
Meeker, Melissa
Brown, Janene
Lovasi, Gina S
Adhikari, Samranchana
Kanchi, Rania
Avramovic, Sanja
Imperatore, Giuseppina
Poulsen, Melissa N
Mediation of an association between neighborhood socioeconomic environment and type 2 diabetes through the leisure-time physical activity environment in an analysis of three independent samples
title Mediation of an association between neighborhood socioeconomic environment and type 2 diabetes through the leisure-time physical activity environment in an analysis of three independent samples
title_full Mediation of an association between neighborhood socioeconomic environment and type 2 diabetes through the leisure-time physical activity environment in an analysis of three independent samples
title_fullStr Mediation of an association between neighborhood socioeconomic environment and type 2 diabetes through the leisure-time physical activity environment in an analysis of three independent samples
title_full_unstemmed Mediation of an association between neighborhood socioeconomic environment and type 2 diabetes through the leisure-time physical activity environment in an analysis of three independent samples
title_short Mediation of an association between neighborhood socioeconomic environment and type 2 diabetes through the leisure-time physical activity environment in an analysis of three independent samples
title_sort mediation of an association between neighborhood socioeconomic environment and type 2 diabetes through the leisure-time physical activity environment in an analysis of three independent samples
topic Epidemiology/Health services research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9980357/
https://www.ncbi.nlm.nih.gov/pubmed/36858436
http://dx.doi.org/10.1136/bmjdrc-2022-003120
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