Local environmental attributes and type 2 diabetes: Green amenities, walkability indicators, and air pollution are associated with incidence

Although multiple environmental attributes have been associated with type 2 diabetes (T2D) incidence, longitudinal evidence is needed that accounts for co-exposures and key confounding variables. This study estimates associations between environmental attributes (i.e., green amenities, air pollution, neighborhood walkability indicators, and availability of food retailers) and T2D incidence. Records came from the Utah Population Database and included individuals born from 1970 to 1990 and their parents residing in the four-county urban core of Utah (N = 909,729). T2D diagnoses came from multiple health data sources, spanning from 1996 to 2019. Time-varying environmental attributes were objectively measured, and covariate adjustment included area- and individual-level socioeconomic characteristics, geographic correlates of environmental attributes, and family history of T2D. Results from Cox regression models indicated that higher block group-level residential greenness (HR = 0.945, 95% CI: 0.92, 0.97), green land cover (HR = 0.984, 95% CI: 0.97, 1.00), and active commuting rate (HR = 0.964, 95% CI: 0.95, 0.98) were independently associated with reduced T2D hazard. In contrast, higher concentration of ambient particulate matter (HR = 1.079, 95% CI: 1.04, 1.12) and intersection density (HR = 1.026, 95% CI: 1.01, 1.04) were associated with increased T2D hazard. Population density and food retailer availability were not associated with T2D hazard. Inferences were similar in sensitivity tests that aimed to remove prevalent cases, accounted for period effects, and modeled attributes at the scale of census tracts. Our findings suggest that green amenities, air pollution, and land use should not be overlooked in societal efforts to improve population-level metabolic health.