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10-Year Diabetes-Related Survival and Active Living Environments a CANADIAN LINKED DATA STUDY

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10-Year Diabetes-Related Survival and Active Living Environments a CANADIAN LINKED DATA STUDY 10-Year Diabetes-Related Survival and Active Living Environments A CANADIAN LINKED DATA STUDY Sarah M Mah, Claudia Sanmartin, Kaberi Dasgupta, Nancy Ross IPDLN Conference 2018 – Banff, Canada Type 2 Diabetes Metabolic disorder stemming from insulin insensitivity that results in hyperglycaemia and insulin deficiency Accounts for 85%-90% of diabetes cases Complications: cardiovascular disease, nerve damage, kidney disease, eye/foot damage Estimated 50% could be prevented or delayed by diet and physical activity International Diabetes Federation (IDF), Diabetes Atlas, 8th Edition (2017) 2 Drivers of obesity - the main pre-condition of T2D Swinburn, et al., (2011). The global obesity pandemic: shaped by global drivers and local environments. The Lancet, 378(9793), 804-814. Changing neighbourhoods is associated with BMI over time Wasfi, R. A., Dasgupta, K., Orpana, H., & Ross, N. A. (2016). American journal of public health. Walkable environments and T2D Stockholm, Sweden (Sundquist et al., 2015) • 512,061 individuals • More walkable neighbourhoods associated with 4-year incidence of type 2 diabetes before adjusting for individual-level covariates Ontario, Canada (Creatore et al., 2016) • An ecological study of 8777 neighbourhoods • More highly walkable neighbourhoods associated with decreased prevalence of overweight, obesity, and incidence of diabetes over time The impact of walkable environments on mortality related to T2D is unknown. Using Canadian linked data to address environment and health Canadian Neighbourhood Community Health Canadian Mortality Environment Survey Database Geographic Sociodemographic Date of birth/death Information Systems characteristics Cause of death (GIS) Health behaviors Postal code The Canadian Active Living Environments Measure (Can-ALE) • Active Living Environments (ALEs): Neighbourhoods that support, encourage and promote physical activity • Can-ALE: National dataset of Geographic Information Systems (GIS) measures that characterize the active living environments (ALEs) of Canadian communities • Contains four measures • Three-way intersection density • Dwelling density • Destination density • Transit stops* • Derived using free and open data sources Modeling the relationship between built environment and chronic disease survival LINKED DATA T2D/RISK IDENTIFICATION ANALYSIS (Ng et al., 2008) 00 Active Living Cox Proportional General Population Environment (ALE) Hazards Models Mortality Health Survey High-risk for Type 2 Diabetes (Rosella et al., 2011) • Age Mortality • Sex • Education Type 2 Diabetes • Smoking status (Ng et al., 2008) • Other chronic conditions • Obesity • Leisure walking Walking is consistently patterned by neighbourhood environment Modest survival gains for residents in favourable ALE environments All-cause mortality CVD/diabetes-related mortality HR (95% CI) HR (95% CI) Whole Whole population population Whole Whole population population (adjusted) (adjusted) high-risk T2D high-risk T2D population population T2D population T2D population T2D population T2D population (adjusted) (adjusted) 0.25 0.45 0.65 0.85 1.05 1.25 0.25 0.45 0.65 0.85 1.05 1.25 high ALE beneficial high ALE beneficial Individual leisure walking might impact the neighbourhood survival advantage All-cause death Individual leisure walking might impact the neighbourhood survival advantage Cardio-vascular /diabetes death Main findings 1. More walking in Canadian neighbourhoods that are conducive to active living 2. Modest survival gains related to cardiovascular disease and diabetes for the general population 3. Inconclusive benefit for those at higher risk of developing type 2 diabetes; no evidence for individuals with type 2 diabetes 4. Neighbourhood advantage depends on whether individuals reported walking for leisure Implications Active living environments are meaningful to neighbourhood-based physical activity in the Canadian population The general population appears responsive to active living environments; could be beneficial for those at high risk of developing type 2 diabetes Investing in the built environment could contribute to long-term population health strategies for preventing chronic disease incidence, health care cost, and mortality Acknowledgements Geosocial Determinants of Health Research Group Statistics Canada - Health Analytics Division nancyrossresearchgroup.ca Type 2 Diabetes (T2D) Type 2 Diabetes: a metabolic disorder stemming from insulin insensitivity that results in hyperglycaemia and insulin deficiency Characteristics: ◦ Insulin resistance ◦ Insulin production defect (beta cell dysfunction) ◦ Increase glucose production in the liver Complications: cardiovascular disease, nerve damage, kidney disease, eye/foot damage 85%-90% of diabetes cases are type II 17 Active Living Environments (ALEs) Neighbourhoods that support, encourage and promote physical activity ➢Otherwise known as ’walkability’ in the literature ➢Clustered measure of neighbourhood design, density, and diversity ➢Associations with walking, physical activity, lower obesity rates, and lower chronic conditions 18 Deriving an open-source measure for active living environments (Can-ALE) OpenStreetMap Postal Code OSM Street Regional Census Dwelling Points of Interest coordinates Network Files Boundary Files Counts Neighbourhood buffers (1000 m) Points of Interest Street Connectivity Dwelling Density The number of potential walking 3+way intersection density Population dwelling count divided by destinations boundary area Active Living Environment Classes 1-5 1= least favourable 5 = most favourable 19.
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