Diabetes Risk Higher in Less Walkable Neighbourhoods: Study

By Ryan McGreal
Published September 19, 2012

this blog entry has been updated

From the Yet More Evidence Telling Us What We Already Know dept:

A recent cohort study conducted in Toronto and published in the peer reviewed journal Diabetes Care concludes that a neighbourhood's walkability is a strong predictor of the incidence of diabetes, especially among recent immigrants.

The researchers looked at everyone in Toronto between 30 and 65 and controlled for age, income and immigrant status. Among all groups - low-income recent immigrants, low-income long-term residents, high-income recent immigrants and high-income long-term residents - the rate of incidence of diabetes was lower in more walkable neighbourhoods.

However, the biggest increase in risk of incidence was among low-income recent immigrants, who had a 50% higher risk of getting diabetes in the least walkable neighbourhoods compared to the most walkable.

Comparing across cohorts, low-income immigrants living in the least walkable neighbourhoods have three times the risk of getting diabetes as high-income immigrants living in the most walkable neighbourhoods.

(h/t to the always-informative Atlantic Cities for highlighting the study)

Update: as recommended by John Neary in this comment, I have edited this blog entry to make more explicit the fact that the study recorded the incidence of diabetes, i.e. the rate of new cases of diabetes among the cohorts, and not the pre-existing prevalence of diabetes.

Ryan McGreal, the editor of Raise the Hammer, lives in Hamilton with his family and works as a programmer, writer and consultant. Ryan volunteers with Hamilton Light Rail, a citizen group dedicated to bringing light rail transit to Hamilton. Ryan writes a city affairs column in Hamilton Magazine, and several of his articles have been published in the Hamilton Spectator. He also maintains a personal website and has been known to post passing thoughts on Twitter @RyanMcGreal. Recently, he took the plunge and finally joined Facebook.


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By LOL all over again (anonymous) | Posted September 19, 2012 at 21:03:39

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By John Neary (registered) | Posted September 21, 2012 at 21:30:15 in reply to Comment 81061

No, because this study looked at the risk of developing diabetes and not at the risk of having diabetes at baseline.

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By John Neary (registered) | Posted September 19, 2012 at 21:36:44

Ryan, I'd advise that you edit this post to emphasize that this study looked at the incidence of diabetes (i.e. the frequency with which people who did not initially have diabetes developed the condition) rather than the prevalence of diabetes* (i.e. the proportion of people who had diabetes on study entry).

You use the word "incidence" once in the second paragraph, but then use phrases such as "the rate of diabetes", "50% higher risk of diabetes", "three times the risk of diabetes" which could easily be taken as referring to prevalence. I'd insert the word "incident" before "diabetes" in each of those phrases, and also define the term "incidence" for readers who aren't familiar with it.

(Similar to the previous poster, I assumed that the results of this study were hopelessly confounded by the fact that socioeconomic status is a predictor of both neighbourhood of residence and risk of diabetes. That the study examined incident rather than prevalent diabetes mitigates the importance of that confounding somewhat.)

Really interesting article -- thanks for posting.

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By Ryan (registered) - website | Posted September 20, 2012 at 06:10:26 in reply to Comment 81064

Good point, John. I've updated the blog entry to emphasize this more strongly.

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By victorlopes (registered) | Posted September 20, 2012 at 01:03:21

Well, Yeah Recently I've also read an article on this in the Indian Express. That People living in less walkable neighbourhoods have more risk of developing diabetes.

Comment edited by victorlopes on 2012-09-20 01:04:02

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By LOL all over again (anonymous) | Posted September 20, 2012 at 10:02:58

Wouldn't a better assumption be that since the homes in less walkable areas are cheaper than the homes in more walkable areas the whole thing can be attributed to income rather then walkability of the neighbourhood?

And yes you are right this is something that we already knew.

It's all about cause and effect.

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By Ryan (registered) - website | Posted September 20, 2012 at 10:15:43 in reply to Comment 81091

As I noted in the blog post, the study controls for income, and walkability is independently correlated with diabetes incidence.

I'm really at a loss to comprehend why you are so profoundly averse to the extensively researched and well-supported argument that designing streets to be accessible to all modes of transportation is successful at producing healthier communities.

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By LOL all over again (anonymous) | Posted September 22, 2012 at 06:10:39 in reply to Comment 81094

Because it just does not make sense and I am a big believer in common sense, even though it is not very common any more. If the walkability (whatever that is) of the street really made a difference then why would new immigrants be more susceptible? If the walkability of the streets were truly the cause then every one would be affected equally not one group more than the other.

It's all about cause and effect. You, like so many other evangelists, see two numbers linked in a study like this and jump to the erroneous conclusion that one is the cause for the other. In many cases that is not the case.

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By sensor (anonymous) | Posted September 24, 2012 at 14:35:27 in reply to Comment 81148

Wait, it doesn't make sense to you that people are healthier in neighbourhoods where it's easier and more pleasant to be active?

The strange thing would be if that wasn't the case!

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By Ryan (registered) - website | Posted September 22, 2012 at 13:48:26 in reply to Comment 81148

Your "common sense" is empirically false here, as John Neary tried to point out here and here and I tried to point out here.

Do you understand what it means to say that a study controlled for a variable? You are suggesting that ethnicity is a confounding variable, but the researchers explicitly took ethnicity into account when determining the risk of getting diabetes as a function of neighbourhood walkability, as I pointed out in the blog entry and as John further clarified in a comment.

What the study tells us is that regardless of a person's ethnicity or income, a person in a less walkable neighbourhood is at higher risk of getting diabetes than a person in a more walkable neighbourhood. That is, empirically, diabetes is independently correlated with ethnicity, income and neighbourhood walkability.

I can't put it more bluntly than this: a poor immigrant living in a more walkable neighbourhood has a lower risk of getting diabetes than a similarly poor immigrant living in a less walkable neighbourhood.

What you call "common sense" is the comforting but often misleading tendency to go on believing what you already believed, instead of carefully testing those beliefs in controlled study. That's not a good way to go about forming opinions on public policy.

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By Pxtl (registered) - website | Posted September 20, 2012 at 11:28:40 in reply to Comment 81094

Because accepting that might mean accepting that his commute really should be 4 minutes longer so we can have an actually functional, viable downtown.

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