Exercise facility availability and incidence of type 2 diabetes and complications in Spain: A population-based retrospective cohort 2015–2018. (May 2023)

• Record Type: Journal Article
• Authors: Cereijo, Luis; Gullón, Pedro; del Cura, Isabel; Valadés, David; Bilal, Usama; Franco, Manuel; Badland, Hannah
• Is Part Of: Health & place. Volume 81(2023)
• Publication Date: 2023-05
• Subjects: Exercise -- Urban health -- Inequalities -- Social determinants of health -- Type 2 diabetes -- Diabetes complications -- Cardiovascular diseases -- Electronic medical records; CI Confidence Interval -- EMR Electronic Medical Records -- ICPC International Classification of Primary Care -- RR Risk Ratio -- SES Socioeconomic Status -- RECORD Reporting of studies Conducted using Observational Routinely-collected Data -- IQR Interquartile Range Interval; Health -- Social aspects -- Periodicals; Health services accessibility -- Periodicals; Public health -- Periodicals; Political planning -- Periodicals; Social medicine -- Periodicals; Epidemiology -- Periodicals; Health Policy -- Periodicals; Health Services Accessibility -- Periodicals; Public Health -- Periodicals; Public Policy -- Periodicals; Sociology, Medical -- Periodicals; Épidémiologie -- Périodiques; Politique sanitaire -- Périodiques; Santé, Services de -- Accessibilité -- Périodiques; Health services accessibility; Health -- Social aspects; Political planning; Public health; Social medicine; Periodicals; 613
• DOI: 10.1016/j.healthplace.2023.103027
• Languages: English
• ISSNs: 1353-8292

Abstract

Abstract: Background: To study the association between exercise facility availability and type 2 diabetes incidence and its complications, and to explore effect modification by socioeconomic status (SES) and sex in the Madrid adult population. Methods: A multilevel longitudinal design, based on a population-based retrospective cohort including 1, 214, 281 residents of Madrid (Spain) aged 40–75 years from 2015 to 2018. Outcomes were type 2 diabetes incidence and macrovascular (cardiac ischemia and/or stroke) and microvascular (chronic kidney disease, retinopathy, and/or peripheral vascular disease) complications in those with diabetes at baseline. Exercise facility availability was defined as the count of exercise facilities in a 1000 m street network buffer around each participant's residence. Poisson regression models with robust standard errors were used to estimate the risk ratios (RR). Interactions were explored with SES tertiles and by sex. Results: Residents living in areas with lower exercise facility availability showed higher risk of type 2 diabetes (RRtertile3vs1 = 1.25, CI95% 1.21–1.30) as well as macrovascular (RRTertile 3vs1 = 1.09 CI95% 1.00–1.19), and microvascular (RRTertile 3vs1 = 1.10 CI95% 1.01–1.19) complications. Associations were strongest in low SES areas for type 2 diabetes (RRtertile3vs1-LOW-SES = 1.22, CI95% 1.12–1.32; RRtertile3vs1-HIGH-SES = 0.91, CI95% 0.85–0.98) and microvascular complications (RRtertile3vs1-LOW-SES = 1.12, CI95% 0, 94–1, 33; RRtertile3vs1-HIGH-SES = 0.88, CI95% 0.73–1.05). Conclusions: Living in areas with lower availability of exercise facilities was associated with a greater risk of type 2 diabetes and its complications. Increasing exercise opportunities, particularly in low SES areas, could help reduce the social gradient of diabetes and its complications. Highlights: First study analysing effect of exercise facilities on diabetes and its complications. Low exercise facilities availability is associated with higher risk of type 2 diabetes. Results showed the same effect for microvascular and macrovascular complications. People living in low SES areas showed stronger associations, especially for men. Our results reinforce the role of exercise facilities availability on diabetes burden.