Urban Sprawl and the Prevalence of Diabetes

Urban Sprawl and the Prevalence of Diabetes In North America, trends in ur In North America, trends in urban development over the past 30 years have resulted in sprawling, car-oriented communities. Research suggests that residents living in older, more traditionally-designed urban neighbourhoods are less sedentary and have lower rates of obesity than those living in newer, suburban developments. We examined the relationship between the urban built environment, walking and other travel patterns, and local diabetes rates in Toronto, Canada.
We used commercial, census, land use, survey and health-related data to assign characteristics to 140 Toronto neighbourhoods. An Activity Friendly Index (AFI) was constructed using neighbourhood rates of car ownership, population density, commercial service density and accessibility and crime, all equally weighted. Spearman correlation coefficients were used to examine associations between variables and ordinary least-squares regression was used to control for neighbourhood income, education and immigration. The Ontario Diabetes Database, a validated electronic diabetes registry created using administrative health data, was used to calculate age-/sex-adjusted diabetes rates by neighbourhood.
The outer, more suburban areas of the city were less activity-friendly and had higher rates of car ownership than older neighbourhoods. AFI values were directly correlated to the number of walking/bicycling trips per capita (R=0.597, p<.01), as were the following individual components of the index: population density (R=0.607), number of retail services per capita (R=0.461), distance to the nearest five commercial services (R= -0.604), and the number of cars per household (R= -0.604). Overall, the neighbourhood AFI was inversely correlated to age-/sex-adjusted diabetes rates (R= -0.235), with areas that were the least ‘activity-friendly’ having the highest rates. This association remained significant after controlling for neighbourhood income, education and immigration (p<.001), and was strongest in ‘high-risk’ communities characterized by lower socioeconomic status (SES) and a higher proportion of non-white ethnic groups (R= -0.540, p<.001).
The neighbourhoods in which we live may act as a barrier or facilitator to walking and other physical activities. Environmental factors may be important avenues for intervention to enhance physical activity and lower the rate of diabetes and other obesity-related conditions. GILLIAN L. BOOTH, PETER GOZDRYA, MARIA I. CREATORE, RICHARD H. GLAZIER, Toronto, ON, Canada 1024-P Toronto, ON, Canada Epidemiology