The association between neighbourhood greenspace and type 2 diabetes in a large cross-sectional study

Danielle H Bodicoat, Gary O'Donovan, Alice M Dalton, Laura J Gray, Thomas Yates, Charlotte Edwardson, Sian Hill, David R Webb, Kamlesh Khunti, Melanie J Davies, Andrew P Jones, Danielle H Bodicoat, Gary O'Donovan, Alice M Dalton, Laura J Gray, Thomas Yates, Charlotte Edwardson, Sian Hill, David R Webb, Kamlesh Khunti, Melanie J Davies, Andrew P Jones

Abstract

Objective: To investigate the relationship between neighbourhood greenspace and type 2 diabetes.

Design: Cross-sectional.

Setting: 3 diabetes screening studies conducted in Leicestershire, UK in 2004-2011. The percentage of greenspace in the participant's home neighbourhood (3 km radius around home postcode) was obtained from a Land Cover Map. Demographic and biomedical variables were measured at screening.

Participants: 10,476 individuals (6200 from general population; 4276 from high-risk population) aged 20-75 years (mean 59 years); 47% female; 21% non-white ethnicity.

Main outcome measure: Screen-detected type 2 diabetes (WHO 2011 criteria).

Results: Increased neighbourhood greenspace was associated with significantly lower levels of screen-detected type 2 diabetes. The ORs (95% CI) for screen-detected type 2 diabetes were 0.97 (0.80 to 1.17), 0.78 (0.62 to 0.98) and 0.67 (0.49 to 0.93) for increasing quartiles of neighbourhood greenspace compared with the lowest quartile after adjusting for ethnicity, age, sex, area social deprivation score and urban/rural status (Ptrend=0.01). This association remained on further adjustment for body mass index, physical activity, fasting glucose, 2 h glucose and cholesterol (OR (95% CI) for highest vs lowest quartile: 0.53 (0.35 to 0.82); Ptrend=0.01).

Conclusions: Neighbourhood greenspace was inversely associated with screen-detected type 2 diabetes, highlighting a potential area for targeted screening as well as a possible public health area for diabetes prevention. However, none of the risk factors that we considered appeared to explain this association, and thus further research is required to elicit underlying mechanisms.

Trial registration number: This study uses data from three studies (NCT00318032, NCT00677937, NCT00941954).

Keywords: DIABETES & ENDOCRINOLOGY; EPIDEMIOLOGY; PUBLIC HEALTH.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Figures

Figure 1
Figure 1
ORs of screen-detected type 2 diabetes mellitus in relation to quartiles of neighbourhood greenspace in 10 476 participants. Missing data were imputed so analyses included all participants. Lowest quartile is referent category. Q2, Quartile 2; Q3, Quartile 3. Model 1 was adjusted for ethnicity, age, sex, area social deprivation score, and urban/rural status. Model 2 was adjusted for all variables in model 1 plus body mass index and physical activity (total metabolic equivalents (METS)). Model 3 was adjusted for all variables in model 2 plus fasting glucose, 2 h glucose, and total cholesterol.

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