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The Multi-Ethnic Study of Atherosclerosis

Amy H. Auchincloss, PhD, MPH; Ana V. Diez Roux, MD, PhD; Mahasin S. Mujahid, PhD, MS; Mingwu Shen, MS; Alain G. Bertoni, MD, MPH; Mercedes R. Carnethon, PhD

Arch Intern Med. 2009;169(18):1698-1704.

Background  Despite increasing interest in the extent to which features of residential environments contribute to incidence of type 2 diabetes mellitus, no multisite prospective studies have investigated this question. We hypothesized that neighborhood resources supporting physical activity and healthy diets are associated with a lower incidence of type 2 diabetes.

Methods  Person-level data came from 3 sites of the Multi-Ethnic Study of Atherosclerosis, a population-based, prospective study of adults aged 45 to 84 years at baseline. Neighborhood data were derived from a population-based residential survey. Type 2 diabetes was defined as a fasting glucose level of 126 mg/dL or higher (7 mmol/L) or taking insulin or oral hypoglycemic agents. We estimated the hazard ratio of type 2 diabetes incidence associated with neighborhood (US Census tract) resources.

Results  Among 2285 participants, 233 new type 2 diabetes cases occurred during a median of 5 follow-up years. Better neighborhood resources, determined by a combined score for physical activity and healthy foods, were associated with a 38% lower incidence of type 2 diabetes (hazard ratio corresponding to a difference between the 90th and 10th percentiles for resource distribution, 0.62; 95% confidence interval, 0.43-0.88 adjusted for age, sex, family history of diabetes, race/ethnicity, income, assets, educational level, alcohol use, and smoking status). The association remained statistically significant after further adjustment for individual dietary factors, physical activity level, and body mass index.

Conclusion  Better neighborhood resources were associated with lower incidence of type 2 diabetes, which suggests that improving environmental features may be a viable population-level strategy for addressing this disease.

Author Affiliations: Department of Epidemiology and Biostatistics, School of Public Health, Drexel University, Philadelphia, Pennsylvania (Dr Auchincloss); Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor (Dr Diez Roux and Ms Shen); Department of Epidemiology, School of Public Health, University of California, Berkeley (Dr Mujahid); Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina (Dr Bertoni); and Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (Dr Carnethon).

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