Is a hilly neighborhood environment associated with diabetes mellitus among older people? Results from the JAGES 2010 study

Takeo Fujiwara; Iseki Takamoto; Airi Amemiya; Masamichi Hanazato; Norimichi Suzuki; Yuiko Nagamine; Yuri Sasaki; Yukako Tani; Aki Yazawa; Yosuke Inoue; Kokoro Shirai; Yugo Shobugawa; Naoki Kondo; Katsunori Kondo

doi:10.1016/j.socscimed.2017.04.008

Is a hilly neighborhood environment associated with diabetes mellitus among older people? Results from the JAGES 2010 study

Soc Sci Med. 2017 Jun:182:45-51. doi: 10.1016/j.socscimed.2017.04.008. Epub 2017 Apr 10.

Authors

Takeo Fujiwara¹, Iseki Takamoto², Airi Amemiya³, Masamichi Hanazato⁴, Norimichi Suzuki⁴, Yuiko Nagamine⁴, Yuri Sasaki⁴, Yukako Tani⁵, Aki Yazawa⁶, Yosuke Inoue⁷, Kokoro Shirai⁸, Yugo Shobugawa⁹, Naoki Kondo¹⁰, Katsunori Kondo¹¹

Affiliations

¹ Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan. Electronic address: fujiwara.hlth@tmd.ac.jp.
² Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
³ Department of Social Medicine, National Research Institute for Child Health and Development, Tokyo, Japan.
⁴ Center for Preventive Medical Sciences, Chiba University, Chiba City, Chiba, Japan.
⁵ Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan.
⁶ Department of Human Ecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁷ Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, USA.
⁸ Department of Human Sciences, School of Law and Letters, University of the Ryukyus, Okinawa, Japan.
⁹ Division of International Health, Graduate School of Medical and Dental Science, Niigata University, Niigata, Japan.
¹⁰ Department of Health Education and Health Sociology, School of Public Health, The University of Tokyo, Tokyo, Japan.
¹¹ Center for Well-being and Society, Nihon Fukushi University, Aichi, Japan; Department of Gerontology and Evaluation Study, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan.

PMID: 28412640
DOI: 10.1016/j.socscimed.2017.04.008

Abstract

Background: Although living in a hilly environment may promote muscular activity in the daily lives of residents, and such activity may prevent diabetes mellitus, few studies have focused on the impact of living in a hilly environment on diabetes mellitus. The purpose of this study was to investigate the impact of a hilly neighborhood environment on DM in older people.

Methods: We used data from the Japan Gerontological Evaluation Study, a population-based, cross-sectional study of individuals aged 65 or older without long-term care needs in Japan, which was conducted in 2010. A total of 8904 participants in 46 neighborhoods had responded to the questionnaire and undergone a health check. Diabetes mellitus was diagnosed as HbA_1c ≥ 6.5% and those undergoing treatment for diabetes mellitus. Poorly controlled diabetes mellitus was diagnosed in those without other chronic diseases who had an HbA_1c > 7.5%, and in those with other chronic diseases if their HbA_1c was >8.0%. Neighborhood environment was evaluated based on the percentage of positive responses in the questionnaire and geographical information system data. A multilevel analysis was performed, adjusted for individual-level risk factors. Furthermore, sensitivity analysis was conducted for those who were undergoing treatment for diabetes mellitus (n = 1007).

Results: After adjustment for other physical environmental and individual covariates, a 1 interquartile range increase (1.48°) in slope in the neighborhood decreased the risk of poorly controlled diabetes mellitus by 18% (odds ratio [OR]: 0.82, 95% confidence interval [CI]: 0.70-0.97). Sensitivity analysis confirmed that larger slopes in the neighborhood showed a significant protective effect against diabetes mellitus among those who were undergoing treatment for diabetes mellitus (OR: 0.73, 95% CI: 0.59-0.90).

Conclusion: A hilly neighborhood environment was not associated with diabetes mellitus, but was protective against poorly controlled diabetes mellitus.

Keywords: Diabetes; Elderly; Neighborhood; Physical environment; Slope; Steps.

MeSH terms

Aged
Aged, 80 and over
Cross-Sectional Studies
Diabetes Mellitus / epidemiology*
Educational Status
Employment / methods
Employment / statistics & numerical data
Environment*
Female
Geographic Mapping*
Glycated Hemoglobin / analysis
Humans
Income / statistics & numerical data
Japan / epidemiology
Male
Multilevel Analysis
Odds Ratio
Residence Characteristics / statistics & numerical data*
Risk Factors

Substances

Glycated Hemoglobin A
hemoglobin A1c protein, human