Neighborhood greenspace and risk of type 2 diabetes in a prospective cohort: the Multi-Ethnic Study of Atherosclerosis

Annie Doubleday,Marnie F Hazlehurst,Alain G Bertoni,Anjum Hajat,Joel D Kaufman,Catherine J Knott

doi:10.1186/s12940-021-00824-w

Annie Doubleday, Marnie F Hazlehurst + Show 4 more

Open Access

https://doi.org/10.1186/s12940-021-00824-w

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Abstract

BackgroundNeighborhood greenspaces provide opportunities for increased physical activity and social interaction, and thus may reduce the risk of Type 2 diabetes. However, there is little robust research on greenspace and diabetes. In this study, we examine the longitudinal association between neighborhood greenspace and incident diabetes in the Multi-Ethnic Study of Atherosclerosis.MethodsA prospective cohort study (N = 6814; 2000-2018) was conducted to examine the association between greenspace, measured as annual and high vegetation season median greenness determined by satellite (Normalized Difference Vegetation Index) within 1000 m of participant homes, and incident diabetes assessed at clinician visits, defined as a fasting glucose level of at least 126 mg/dL, use of insulin or use of hypoglycemic medication, controlling for covariates in stages. Five thousand five hundred seventy-four participants free of prevalent diabetes at baseline were included in our analysis.ResultsOver the study period, 886 (15.9%) participants developed diabetes. Adjusting for individual characteristics, individual and neighborhood-scale SES, additional neighborhood factors, and diabetes risk factors, we found a 21% decrease in the risk of developing diabetes per IQR increase in greenspace (HR: 0.79; 95% CI: 0.63, 0.99).ConclusionsOverall, neighborhood greenspace provides a protective influence in the development of diabetes, suggesting that neighborhood-level urban planning that supports access to greenspace--along with healthy behaviors--may aid in diabetes prevention. Additional research is needed to better understand how an area’s greenness influences diabetes risk, how to better characterize greenspace exposure and usage, and future studies should focus on robust adjustment for neighborhood-level confounders.

Highlights

Neighborhood greenspaces provide opportunities for increased physical activity and social interaction, and may reduce the risk of Type 2 diabetes
We examine the association between greenspace exposure and the development of incident diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA)
The distribution of Normalized Difference Vegetation Index (NDVI) is skewed by study site, with some sites having predominantly high NDVI and more vegetated landscapes, while others have a wider range of NDVI (Fig. S1)

Summary

Introduction

Neighborhood greenspaces provide opportunities for increased physical activity and social interaction, and may reduce the risk of Type 2 diabetes. There is little robust research on greenspace and diabetes. We examine the longitudinal association between neighborhood greenspace and incident diabetes in the Multi-Ethnic Study of Atherosclerosis. Research has focused on the role of the larger neighborhood social and physical environments, including modifiable community-scale factors such as greenspace, in diabetes risk and prevention. There is a growing body of research on the association between neighborhood greenspace and diabetes [7,8,9,10,11,12,13,14,15,16]. Greenspace is hypothesized to act through multiple mechanisms, including through increasing physical activity and reduced stress. The degree to which greenspace operates independently on diabetes is not well understood [3,4,5,6]

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