American Diabetes Association
DC22-1549 Supplementary_online-only_material_revision_clean.docx (249.93 kB)

Higher neighbourhood drivability is associated with a higher diabetes risk in younger adults: a population-based cohort study in Toronto, Canada

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posted on 2023-03-03, 16:20 authored by Nicolette R. den Braver, Joline WJ Beulens, C. Fangyun Wu, Ghazal S. Fazli, Peter Gozdyra, Nicholas A Howell, Jeroen Lakerveld, John S. Moin, Femke Rutters, Johannes Brug, Rahim Moineddin, Gillian L. Booth


Objective: Car dependency contributes to physical inactivity and consequently may increase the likelihood of diabetes. We investigated whether neighbourhoods that are highly conducive to driving confer a greater risk of developing diabetes, and if so whether this differs by age.

Research Design and Methods: We used administrative healthcare data to identify all working-aged Canadian adults (20-64 years) who were living in Toronto on April 1st 2011 without diabetes (type 1 or 2). Neighbourhood drivability scores were assigned using a novel, validated index that predicts driving patterns based on built environment features, divided into quintiles (Q). Cox regression was used to examine the association between neighbourhood drivability and 7-year risk of diabetes onset, overall and by age group, adjusting for baseline characteristics and comorbidities.

Results: Overall, there were 1,473,994 adults in the cohort (mean age 40.9±12.2), among whom 77,835 developed diabetes during follow-up. Those living in the most drivable neighbourhoods (Q5) had a 41% higher risk of developing diabetes compared to those in the least drivable neighbourhoods (adjusted HR: 1.41, 95%CI 1.37–1.44), with strongest associations in younger adults aged 20-34 years (1.57, 95%CI 1.47–1.68, p<0.001 for interaction). The same comparison in older adults (55-64 years) yielded smaller differences (1.31, 95%CI 1.26–1.36). Associations appeared to be strongest in middle-income neighbourhoods, for younger residents (middle income: 1.96, 95%CI 1.64-2.33) and older residents (1.46, 95%CI 1.32–1.62).

Conclusions: High neighbourhood drivability was a risk factor for diabetes, particularly in younger adults. This has important implications for future urban design policies.


Canadian Institutes of Health Research (CIHR)

European Foundation for the Study of Diabetes (EFSD) Albert Renold Travel Fellowship

Public Health Research Institute