Longitudinal Analysis of Neighborhood Food Environment and Diabetes Risk in the Veterans Administration Diabetes Risk Cohort
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ABSTRACT:
SUBMITTER: Kanchi R
PROVIDER: S-EPMC8556617 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:PurposeThe veterans administration diabetes risk (VADR) cohort facilitates studies on temporal and geographic patterns of pre-diabetes and diabetes, as well as targeted studies of their predictors. The cohort provides an infrastructure for examination of novel individual and community-level risk factors for diabetes and their consequences among veterans. This cohort also establishes a baseline against which to assess the impact of national or regional strategies to prevent diabetes in veterans.ParticipantsThe VADR cohort includes all 6 082 018 veterans in the USA enrolled in the veteran administration (VA) for primary care who were diabetes-free as of 1 January 2008 and who had at least two diabetes-free visits to a VA primary care service at least 30 days apart within any 5-year period since 1 January 2003, or veterans subsequently enrolled and were diabetes-free at cohort entry through 31 December 2016. Cohort subjects were followed from the date of cohort entry until censure defined as date of incident diabetes, loss to follow-up of 2 years, death or until 31 December 2018.Findings to dateThe incidence rate of type 2 diabetes in this cohort of over 6 million veterans followed for a median of 5.5 years (over 35 million person-years (PY)) was 26 per 1000 PY. During the study period, 8.5% of the cohort were lost to follow-up and 17.7% died. Many demographic, comorbidity and other clinical variables were more prevalent among patients with incident diabetes.Future plansThis cohort will be used to study community-level risk factors for diabetes, such as attributes of the food environment and neighbourhood socioeconomic status via geospatial linkage to residence address information.
| S-EPMC7722386 | biostudies-literature
Project description:Cross-sectional studies suggest that neighborhood socioeconomic (SES) disadvantage is associated with obesogenic food environments. Yet, it is unknown how exposure to neighborhood SES patterning through adulthood corresponds to food environments that also change over time. We used latent class analysis (LCA) to classify participants in the U.S.-based Coronary Artery Risk Development in Young Adults study [n=5,114 at baseline 1985-1986 to 2005-2006] according to their longitudinal neighborhood SES residency patterns (upward, downward, stable high and stable low). For most classes of residents, the availability of fast food and non-fast food restaurants and supermarkets and convenience stores increased (p<0.001). Yet, socioeconomically disadvantaged neighborhood residents had fewer fast food and non-fast food restaurants, more convenience stores, and the same number of supermarkets in their neighborhoods than the advantaged residents. In addition to targeting the pervasive fast food restaurant and convenient store retail growth, improving neighborhood restaurant options for disadvantaged residents may reduce food environment disparities.
| S-EPMC4252601 | biostudies-literature
Project description:We explored links between food environments, dietary intake biomarkers, and sudden cardiac arrest in a population-based longitudinal study using cases and controls accruing between 1990 and 2010 in King County, WA. Surprisingly, presence of more unhealthy food sources near home was associated with a lower 18:1 trans-fatty acid concentration (-0.05% per standard deviation higher count of unhealthy food sources, 95% Confidence Interval [CI]: 0.01, 0.09). However, presence of more unhealthy food sources was associated with higher odds of cardiac arrest (Odds Ratio [OR]: 2.29, 95% CI: 1.19, 4.41 per standard deviation in unhealthy food outlets). While unhealthy food outlets were associated with higher cardiac arrest risk, circulating 18:1 trans fats did not explain the association.
| S-EPMC6245544 | biostudies-literature
Project description:BackgroundThe VHA is the largest integrated US health system and is increasingly moving care into the communities where veterans reside. Veterans who utilize the VA for their care have worse health status than the general population. However, there is limited evidence about the association of neighborhood environment and health outcomes among veterans.ObjectivesThe primary aim of this study is to assess the relative contribution of neighborhood environment, health system, and individual characteristics to health status and mortality of veterans.MethodsInformation on personal socio-economic indicators, existing medical conditions and health status were obtained from baseline data from a multi-site, randomized trial of primary care patients (n = 15,889). The physical component scale (PCS) and mental component scale (MCS) summarized health status. Census tracts were used as proxies for neighborhoods. A summary score based on census tract data characterized the neighborhood socio-economic environment and walkability. Data were analyzed with multilevel hierarchical models. Analyses of health status were cross-sectional. Mortality analyses were longitudinal as participants were followed for an average of 722.5 days to ascertain vital status.ResultsNeighborhood SES was associated with PCS and MCS scores, controlling for individual socio-economic status, self-reported co-morbid disease, smoking status, and health care access. In the lowest versus highest quartiles of neighborhood SES, adjusted PCS scores were 34.4 vs. 35.4 (p < 0.05) and adjusted MCS scores were 46.2 versus 47.0 (p < 0.05). PCS score was also significantly associated with neighborhood walkability (p < 0.05). Mortality was lower for veterans living in neighborhoods with the highest decile neighborhood SES (HR 0.78, highest vs. lowest decile 95% CI 0.63, 0.97).ConclusionsVeterans living in lower SES neighborhoods have poorer health status and a higher risk of mortality, independent of individual characteristics and health care access. Neighborhood walkability was associated with higher PCS scores.
| S-EPMC3138994 | biostudies-literature
Project description:IntroductionInterventions targeting built environmental factors may encourage older people to engage in favorable behaviors and decrease dementia risk, but epidemiologic evidence is limited. This study investigated the association between neighborhood food environment and dementia incidence.MethodsA 3-year follow-up (2010-2013) was conducted among participants in the Japan Gerontological Evaluation Study, a population-based cohort study of older adults aged ?65 years. Dementia incidence for 49,511 participants was assessed through the public long-term care insurance system. Availability of food stores (defined as the number of food stores selling fruits and vegetables within 500 meters or 1 kilometer of residence) was assessed for each participant using objective (GIS-based) and subjective (participant-reported) measurements. Data were analyzed from 2017 to 2018.ResultsA total of 3,162 cases of dementia occurred during the follow-up. Compared with the highest quartile for objective availability of food stores, the hazard ratio adjusting for age and sex was 1.60 (95% CI=1.43, 1.78) for the second-lowest quartile. Compared with the highest subjective availability of food stores, the hazard ratio was 1.74 (95% CI=1.49, 2.04) for the lowest category. After successive adjustment for sociodemographic characteristics, health status, and other geographic neighborhood factors (availability of restaurants, convenience stores, and community centers), the hazard ratio remained statistically significant.ConclusionsLower food store availability was associated with increased dementia incidence. Given that food shopping is a routine activity and a main motive for going out among older adults, increasing the availability of food stores may contribute to dementia prevention.
| S-EPMC6375726 | biostudies-literature
Project description:BACKGROUND:Previous research has linked lower availability of food stores selling fruits and vegetables to unhealthy diet. However, the longitudinal association between the availability of healthy food stores and mortality is unknown. This study examined the association between neighborhood availability of food stores and mortality by driving status among older adults. METHODS:This study drew upon a three-year follow up of participants in the Japan Gerontological Evaluation Study, a population-based cohort study of Japanese adults aged 65 years or older. Mortality from 2010 to 2013 was analyzed for 49,511 respondents. Neighborhood availability of food stores was defined as the number of food stores selling fruits and vegetables within a 500-m or 1-km radius of a person's residence. Both subjective (participant-reported) and objective (geographic information system-based) measurements were used to assess this variable. Cox regression models were used to estimate hazard ratios (HR) for mortality. RESULTS:A total of 2049 deaths occurred during the follow up. Lower subjective availability of food stores was significantly associated with increased mortality. Compared with participants reporting the highest availability, the age- and sex-adjusted HR for those reporting the lowest availability was 1.28 (95% CI: 1.04-1.58; p?=?0.02). The association remained significant after adjustment for sociodemographic (education, income, cohabitation, marital status, and employment status) and environmental (driving status, use of public transportation, and study site) status (HR?=?1.24, 95% CI: 1.01-1.53, p?=?0.04). This association was stronger among non-car users, among whom the HR for those reporting the lowest availability of food stores was 1.61 (95% CI: 1.08-2.41, p?=?0.02). In contrast, no significant association was seen between objective availability and mortality. CONCLUSIONS:Lower availability of healthy food stores measured subjectively, but not objectively, was associated with mortality, especially among non-car users. Considering the decline in mobility with age, living in a neighborhood with many options for procuring fruits and vegetables within walking distance may be important for healthy aging.
| S-EPMC6194719 | biostudies-other
Project description:BackgroundRecent obesity prevention initiatives focus on healthy neighborhood design, but most research examines neighborhood food retail and physical activity (PA) environments in isolation. We estimated joint, interactive, and cumulative impacts of neighborhood food retail and PA environment characteristics on body mass index (BMI) throughout early adulthood.Methods and findingsWe used cohort data from the Coronary Artery Risk Development in Young Adults (CARDIA) Study [n=4,092; Year 7 (24-42 years, 1992-1993) followed over 5 exams through Year 25 (2010-2011); 12,921 person-exam observations], with linked time-varying geographic information system-derived neighborhood environment measures. Using regression with fixed effects for individuals, we modeled time-lagged BMI as a function of food and PA resource density (counts per population) and neighborhood development intensity (a composite density score). We controlled for neighborhood poverty, individual-level sociodemographics, and BMI in the prior exam; and included significant interactions between neighborhood measures and by sex. Using model coefficients, we simulated BMI reductions in response to single and combined neighborhood improvements. Simulated increase in supermarket density (from 25(th) to 75(th) percentile) predicted inter-exam reduction in BMI of 0.09 kg/m(2) [estimate (95% CI): -0.09 (-0.16, -0.02)]. Increasing commercial PA facility density predicted BMI reductions up to 0.22 kg/m(2) in men, with variation across other neighborhood features [estimate (95% CI) range: -0.14 (-0.29, 0.01) to -0.22 (-0.37, -0.08)]. Simultaneous increases in supermarket and commercial PA facility density predicted inter-exam BMI reductions up to 0.31 kg/m(2) in men [estimate (95% CI) range: -0.23 (-0.39, -0.06) to -0.31 (-0.47, -0.15)] but not women. Reduced fast food restaurant and convenience store density and increased public PA facility density and neighborhood development intensity did not predict reductions in BMI.ConclusionsFindings suggest that improvements in neighborhood food retail or PA environments may accumulate to reduce BMI, but some neighborhood changes may be less beneficial to women.
| S-EPMC3874030 | biostudies-literature
Project description:Characteristics of the built environment, including access to unhealthy food outlets, are hypothesized to contribute to type 2 diabetes mellitus (T2D). Swedish nationwide registry data on 4,718,583 adults aged 35-80 years living in 9,353 neighborhoods, each with at least 1 food outlet, were geocoded and linked to commercial registers (e.g., restaurants and grocery stores). Multilevel logistic regression was used to examine the prospective relationship between characteristics of the food environment and T2D from 2005 to 2010. Relative access to health-harming food outlets was associated with greater likelihood of both prevalent and incident T2D in a curvilinear manner, with the highest risk being observed for environments in which one-third of outlets were health-harming. Relative to individuals whose food environment did not change, those who moved into areas with more health-harming food outlets had higher odds of developing T2D (odds ratio = 3.67, 95% confidence interval: 2.14, 6.30). Among those who did not move, living in an area that gained relative access to health-harming food outlets was also associated with higher odds of T2D (odds ratio = 1.72, 95% confidence interval: 1.27, 2.33). These results suggest that local food environment, including changes that result in greater access to unhealthy food outlets, is associated with T2D.
| S-EPMC4908207 | biostudies-other
Project description:There has been increasing interest in associations between neighborhood food environments and cardiovascular risk factors. However, results from high-income countries remain inconsistent, and there has been limited research from low- and middle-income countries. We conducted a cross-sectional analysis of the third wave follow-up of the Andhra Pradesh children and parents study (APCAPS) (n = 5764, median age 28.8 years) in south India. We examined associations between the neighborhood availability (vendor density per km2 within 400 m and 1600 m buffers of households) and accessibility (distance from the household to the nearest vendor) of fruit/vegetable and highly processed/take-away food vendors with 11 cardiovascular risk factors, including adiposity measures, glucose-insulin, blood pressure, and lipid profile. In fully adjusted models, higher density of fruit/vegetable vendors within 400 m of participant households was associated with lower systolic blood pressure [-0.09 mmHg, 95% confidence interval (CI): -0.17, -0.02] and diastolic blood pressure (-0.10 mmHg, 95% CI: -0.17, -0.04). Higher density of highly processed/take-away food vendors within 400 m of participant households was associated with higher Body Mass Index (0.01 Kg/m2, 95% CI: 0.00, 0.01), waist circumference (0.22 mm, 95% CI: 0.05, 0.39), systolic blood pressure (0.03 mmHg, 95% CI: 0.01, 0.06), and diastolic blood pressure (0.03 mmHg, 95% CI: 0.01, 0.05). However, within 1600 m buffer, only association with blood pressure remained robust. No associations were found for between neighborhood accessibility and cardiovascular risk factors. Lower density of fruit/vegetable vendors, and higher density of highly processed/take-away food vendors were associated with adverse cardiovascular risk profiles. Public health policies regarding neighborhood food environments should be encouraged in south India and other rural communities in south Asia.
| S-EPMC6857431 | biostudies-literature
Project description:BackgroundThere is limited longitudinal evidence confirming the role of neighborhood environment attributes in encouraging people to walk more or if active people simply choose to live in activity-friendly neighborhoods. Natural experiments of policy changes to create more walkable communities provide stronger evidence for a causal effect of neighborhood environments on residents' walking.ObjectivesWe aimed to investigate longitudinal associations between objective and perceived neighborhood environment measures and neighborhood recreational walking.MethodsWe analyzed longitudinal data collected over 8 yr (four surveys) from the RESIDential Environments (RESIDE) Study (Perth, Australia, 2003-2012). At each time point, participants reported the frequency and total minutes of recreational walking/week within their neighborhood and neighborhood environment perceptions. Objective measures of the neighborhood environment were generated using a Geographic Information System (GIS).ResultsLocal recreational walking was influenced by objectively measured access to a medium-/large-size park, beach access, and higher street connectivity, which was reduced when adjusted for neighborhood perceptions. In adjusted models, positive perceptions of access to a park and beach, higher street connectivity, neighborhood esthetics, and safety from crime were independent determinants of increased neighborhood recreational walking. Local recreational walking increased by 9 min/wk (12% increase in frequency) for each additional perceived neighborhood attribute present.ConclusionsOur findings provide urban planners and policy makers with stronger causal evidence of the positive impact of well-connected neighborhoods and access to local parks of varying sizes on local residents' recreational walking and health. https://doi.org/10.1289/EHP823.
| S-EPMC5744655 | biostudies-literature