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. 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.
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 HbA1c ≥ 6.5% and those undergoing treatment for diabetes mellitus. Poorly controlled diabetes mellitus was diagnosed in those without other chronic diseases who had an HbA1c > 7.5%, and in those with other chronic diseases if their HbA1c 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.
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 HbA1c ≥ 6.5% and those undergoing treatment for diabetes mellitus. Poorly controlled diabetes mellitus was diagnosed in those without other chronic diseases who had an HbA1c > 7.5%, and in those with other chronic diseases if their HbA1c 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.
Authors: Miwa Yamaguchi; Katsuya Takahashi; Masamichi Hanazato; Norimichi Suzuki; Katsunori Kondo; Naoki Kondo Journal: Int J Environ Res Public Health Date: 2019-03-03 Impact factor: 3.390