Grant: Travel Awards - Institute Community Support

In this study, we investigated whether varying levels of neighbourhood influence the incidence of prediabetes among immigrant populations of ethnicities Population-based databases were used to identify individuals aged 20+ with normal glucose tests on Jan 1, 2002 and followed to Dec 31, 2013, for the development of prediabetes. We used a validated algorithm to categorize people into distinct ethnic groups based on mother tongue and country of birth. Neighbourhood walkability scores were assigned to individuals using their postal code of residence at baseline. Walkability quintiles were divided into two categories: high based on the top quintile (Q5) and low based on the bottom 4 quintiles (Q1-Q4). Cox proportional hazards regression models were used to examine incidence of prediabetes across different ethnic groups, stratifying by high and low walkability, accounting for sociodemographic, environment, and immigrant predictors. Our cohort included 274,013 immigrants (mean age 40 years) from Sub-Saharan Africa/Caribbean, South Asia, Latin America, and Western Europe. Overall, the incidence of prediabetes remained elevated among all non-Europeans groups. However, these effects were more marked in neighbourhoods that were less walkable and reduced in more walkable neighbourhoods. For example, Sub-Saharan African/Caribbeans living in low walkability areas had a twofold higher incidence of prediabetes but only 1.2 times higher in high walkability areas. Additionally, Latin Americans living in low walkability areas had a 1.5-fold higher incidence, compared with Western Europeans (referent population), but this association was not significant in high walkability areas. These patterns persisted for adults aged 20-64, but not for those aged 65+. Neighbourhood walkability may amplify the risk of prediabetes development among immigrant populations of different ethnicities, which is an important finding for guiding future policy and research directions for diabetes prevention.