Is a hilly neighborhood environment associated with diabetes mellitus among older people? Results from the JAGES 2010 study

Soc Sci Med. 2017 Jun:182:45-51. doi: 10.1016/j.socscimed.2017.04.008. Epub 2017 Apr 10.

Abstract

Background: Although living in a hilly environment may promote muscular activity in the daily lives of residents, and such activity may prevent diabetes mellitus, few studies have focused on the impact of living in a hilly environment on diabetes mellitus. The purpose of this study was to investigate the impact of a hilly neighborhood environment on DM in older people.

Methods: We used data from the Japan Gerontological Evaluation Study, a population-based, cross-sectional study of individuals aged 65 or older without long-term care needs in Japan, which was conducted in 2010. A total of 8904 participants in 46 neighborhoods had responded to the questionnaire and undergone a health check. Diabetes mellitus was diagnosed as HbA1c ≥ 6.5% and those undergoing treatment for diabetes mellitus. Poorly controlled diabetes mellitus was diagnosed in those without other chronic diseases who had an HbA1c > 7.5%, and in those with other chronic diseases if their HbA1c was >8.0%. Neighborhood environment was evaluated based on the percentage of positive responses in the questionnaire and geographical information system data. A multilevel analysis was performed, adjusted for individual-level risk factors. Furthermore, sensitivity analysis was conducted for those who were undergoing treatment for diabetes mellitus (n = 1007).

Results: After adjustment for other physical environmental and individual covariates, a 1 interquartile range increase (1.48°) in slope in the neighborhood decreased the risk of poorly controlled diabetes mellitus by 18% (odds ratio [OR]: 0.82, 95% confidence interval [CI]: 0.70-0.97). Sensitivity analysis confirmed that larger slopes in the neighborhood showed a significant protective effect against diabetes mellitus among those who were undergoing treatment for diabetes mellitus (OR: 0.73, 95% CI: 0.59-0.90).

Conclusion: A hilly neighborhood environment was not associated with diabetes mellitus, but was protective against poorly controlled diabetes mellitus.

Keywords: Diabetes; Elderly; Neighborhood; Physical environment; Slope; Steps.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cross-Sectional Studies
  • Diabetes Mellitus / epidemiology*
  • Educational Status
  • Employment / methods
  • Employment / statistics & numerical data
  • Environment*
  • Female
  • Geographic Mapping*
  • Glycated Hemoglobin / analysis
  • Humans
  • Income / statistics & numerical data
  • Japan / epidemiology
  • Male
  • Multilevel Analysis
  • Odds Ratio
  • Residence Characteristics / statistics & numerical data*
  • Risk Factors

Substances

  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human