title: Implications of supermarket access, neighbourhood walkability and poverty rates for diabetes risk in an employee population.
abstract: Diabetes is a growing public health problem, and the environment in which people live and work may affect diabetes risk. The goal of the present study was to examine the association between multiple aspects of environment and diabetes risk in an employee population.
  
  
  
  This was a retrospective cross-sectional analysis. Home environment variables were derived using employees' zip code. Descriptive statistics were run on all individual- and zip-code-level variables, stratified by diabetes risk and worksite. A multivariable logistic regression analysis was then conducted to determine the strongest associations with diabetes risk.
  
  
  
  Data were collected from employee health fairs in a Midwestern health system, 2009-2012.
  
  
  
  The data set contains 25 227 unique individuals across four years of data. From this group, using an individual's first entry into the database, 15 522 individuals had complete data for analysis.
  
  
  
  The prevalence of high diabetes risk in this population was 2·3 %. There was significant variability in individual- and zip-code-level variables across worksites. From the multivariable analysis, living in a zip code with higher percentage of poverty and higher walk score was positively associated with high diabetes risk, while living in a zip code with higher supermarket density was associated with a reduction in high diabetes risk.
  
  
  
  Our study underscores the important relationship between poverty, home neighbourhood environment and diabetes risk, even in a relatively healthy employed population, and suggests a role for the employer in promoting health.
authors.affiliation: 1Division of Endocrinology,Metabolism, and Lipid Research,Department of Medicine,Washington University School of Medicine,Campus Box 8127,660 S. Euclid Avenue,St. Louis,MO 63110,USA.
authors.forename: Cynthia J
authors.identifier: 0000-0001-9696-6018
authors.initials: CJ
authors.lastname: Herrick
authors.affiliation: 2Mercy Research and Mercy Center for Data Innovation,St. Louis,MO,USA.
authors.forename: Byron W
authors.identifier: 0000-0002-3318-6839
authors.initials: BW
authors.lastname: Yount
authors.affiliation: 3Prevention Research Center,George Warren Brown School of Social Work,Washington University,St. Louis,MO,USA.
authors.forename: Amy A
authors.initials: AA
authors.lastname: Eyler
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D015981:Epidemiologic Factors; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011203:Poverty; D012111:Residence Characteristics; D012189:Retrospective Studies; D012307:Risk Factors; D064890:Social Determinants of Health; D016138:Walking
keywords: Diabetes risk; Employee health; Neighbourhood environment; Poverty