The area in which someone lives strongly influences their risk of developing type 2 diabetes, new research from Canada being presented at the annual meeting of the European Association for the Study of Diabetes (EASD) in Milan, Italy (Sept 28 – Oct 2) suggests.
The level of poverty in an individual's neighborhood is known to affect their risk of type 2 diabetes. But it hasn't been clear whether changing neighborhoods matters. Does someone's likelihood of type 2 diabetes fall if they move from a high-poverty neighborhood to one that is less deprived?
To provide an answer, Sharmin Majumder, of the Institute of Health Policy, Management and Evaluation, University of Toronto, and colleagues at a range of other institutions in Toronto, Canada examined data on almost 2 million adults from Ontario, Canada.
Some 1,932,869 men and women (average age of 42.1 years, approximately 51% female) who were free of diabetes and living in high-poverty areas (where ≥30% of households are below Statistics Canada's after-tax Low-Income Cut-Off (LICO)) were followed for up to 21 years.
Individuals who moved from a high-poverty to a lower poverty area were compared with those who moved to another high-poverty area and those whose residential status did not change.
As people who move may be different to people who stay, the researchers used a statistical method called inverse probability weighting to make the groups more similar on measured characteristics such as age, sex, immigration background, neighborhood walkability and city size.
Analysis of the data showed that individuals who moved from a high-poverty to a lower poverty neighborhood developed type 2 diabetes at a 24% lower rate during the follow-up period than those who moved to another high-poverty neighborhood.
They also developed type 2 diabetes at a 57% lower rate than those who did not move at all. (i.e. remained in the same high-poverty area).
These results also suggest that people who remained in the same high-poverty neighborhood were more likely to develop diabetes than those who moved from one high-poverty neighborhood to another high-poverty neighborhood. However, the study was not designed to explain this difference.
People who move may differ from people who do not move in ways that are difficult to fully measure, so this finding should be interpreted cautiously and requires further investigation."
Dr. Sharmin Majumder, Institute of Health Policy, Management and Evaluation, University of Toronto
The researchers concluded that moving from a high-poverty neighborhood to a lower poverty neighborhood was associated with a substantially lower risk of developing type 2 diabetes.
Dr Majumder says: "Lower poverty neighborhoods may differ from high-poverty neighborhoods in many ways that can influence health, including the presence of healthy and affordable food retailers, opportunities for physical activity, such as neighborhood walkability and green spaces, and investments in healthcare and other community resources.
"They may also differ with respect to environmental conditions which can affect stress and health, such as traffic-related air pollution and noise, and opportunities residents have to make social connections.
"Our study was not designed to determine which of these factors explains the lower diabetes risk and identifying these pathways is an important next step."
Learning more is important for urban planning and, so, health, says Dr Majumder.
She explains: "The findings suggest that where people live has important implications for their long-term health.
"Understanding which neighborhood conditions are linked to better health could help inform urban revitalisation efforts and initiatives to improve disadvantaged communities – for example, through better housing, more walkable environments, safe recreational spaces and improved access to community resources."
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