Association between area-level walkability and glycated haemoglobin: a Portuguese population-based study

Area of Science:

• Public Health
• Urban Planning
• Epidemiology

Background:

• Diabetes is a significant global health concern, with physical inactivity as a key risk factor.
• Area-level walkability is a potential modifiable factor to combat physical inactivity and its health consequences.
• Limited research exists on the association between walkability and objective diabetes markers in population-based studies.

Purpose of the Study:

• To investigate the relationship between area-level walkability and individual glycated hemoglobin levels.
• To assess this association in the Portuguese adult population without a diabetes diagnosis.
• To explore potential public health interventions through urban design.

Main Methods:

• A walkability index was created using 2011 census data and street maps, considering density, land use, and connectivity.
• Individual health data (glycated hemoglobin) were obtained from the 2015 National Health Examination Survey (INSEF).
• Gamma regression analysis was used to estimate the associations.

Main Results:

• Residing in moderately walkable areas was associated with significantly lower average glycated hemoglobin levels (Exp(β)=0.906).
• This protective association was less pronounced and not statistically significant in the highest tertile of walkability (Exp(β)=0.919).
• A nonlinear protective effect of walkability on glycated hemoglobin was observed.

Conclusions:

• Area-level walkability demonstrates a nonlinear protective association with glycated hemoglobin levels in Portuguese adults.
• Urban planning and policies promoting walkability may contribute to diabetes prevention strategies.
• Findings underscore the importance of built environment interventions for public health and chronic disease management.