title: Longitudinal Associations Between Neighborhood Physical and Social Environments and Incident Type 2 Diabetes Mellitus: The Multi-Ethnic Study of Atherosclerosis (MESA).
abstract: OBJECTIVE
  Neighborhood environments may influence the risk for developing type 2 diabetes mellitus (T2DM), but, to our knowledge, no longitudinal study has evaluated specific neighborhood exposures.
  
  
  OBJECTIVE
  To determine whether long-term exposures to neighborhood physical and social environments, including the availability of healthy food and physical activity resources and levels of social cohesion and safety, are associated with incident T2DM during a 10-year period.
  
  
  METHODS
  We used data from the Multi-Ethnic Study of Atherosclerosis, a population-based cohort study of adults aged 45 to 84 years at baseline (July 17, 2000, through August 29, 2002). A total of 5124 participants free of T2DM at baseline underwent 5 clinical follow-up examinations from July 17, 2000, through February 4, 2012. Time-varying measurements of neighborhood healthy food and physical activity resources and social environments were linked to individual participant addresses. Neighborhood environments were measured using geographic information system (GIS)- and survey-based methods and combined into a summary score. We estimated hazard ratios (HRs) of incident T2DM associated with cumulative exposure to neighborhood resources using Cox proportional hazards regression models adjusted for age, sex, income, educational level, race/ethnicity, alcohol use, and cigarette smoking. Data were analyzed from December 15, 2013, through September 22, 2014.
  
  
  METHODS
  Incident T2DM defined as a fasting glucose level of at least 126 mg/dL or use of insulin or oral antihyperglycemics.
  
  
  RESULTS
  During a median follow-up of 8.9 years (37,394 person-years), 616 of 5124 participants (12.0%) developed T2DM (crude incidence rate, 16.47 [95% CI, 15.22-17.83] per 1000 person-years). In adjusted models, a lower risk for developing T2DM was associated with greater cumulative exposure to indicators of neighborhood healthy food (12%; HR per interquartile range [IQR] increase in summary score, 0.88 [95% CI, 0.79-0.98]) and physical activity resources (21%; HR per IQR increase in summary score, 0.79 [95% CI, 0.71-0.88]), with associations driven primarily by the survey exposure measures. Neighborhood social environment was not associated with incident T2DM (HR per IQR increase in summary score, 0.96 [95% CI, 0.88-1.07]).
  
  
  CONCLUSIONS
  Long-term exposure to residential environments with greater resources to support physical activity and, to a lesser extent, healthy diets was associated with a lower incidence of T2DM, although results varied by measurement method. Modifying neighborhood environments may represent a complementary, population-based approach to prevention of T2DM, although further intervention studies are needed.
authors.affiliation: Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Christine
authors.affiliation: Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, Pennsylvania.
authors.forename: Amy H
authors.initials: AH
authors.lastname: Auchincloss
authors.affiliation: Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Alain G
authors.initials: AG
authors.lastname: Bertoni
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Mercedes R
authors.initials: MR
authors.lastname: Carnethon
authors.affiliation: Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor.
authors.forename: Brisa N
authors.initials: BN
authors.lastname: Sánchez
authors.affiliation: Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, Pennsylvania.
authors.forename: Kari
authors.initials: K
authors.lastname: Moore
authors.affiliation: Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor.
authors.forename: Sara D
authors.initials: SD
authors.lastname: Adar
authors.affiliation: Department of Medicine and Cardiology, David Geffen School of Medicine, University of California, Los Angeles.
authors.forename: Tamara B
authors.initials: TB
authors.lastname: Horwich
authors.affiliation: Department of Medicine and Cardiology, David Geffen School of Medicine, University of California, Los Angeles.
authors.forename: Karol E
authors.initials: KE
authors.lastname: Watson
authors.affiliation: Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, Pennsylvania.
authors.forename: Ana V
authors.initials: AV
authors.lastname: Diez Roux
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D001213:Asian / Q000706:statistics & numerical data; D002681:China / Q000208:ethnology; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000208:ethnology; D004779:Environment Design; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D005523:Food Supply; D040362:Geographic Information Systems; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012307:Risk Factors; D012931:Social Environment; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data