Association Between Neighborhood Walkability, Type 2 Diabetes, and Socioeconomic Status in Residents of Eight Ohio Counties

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Regular physical activity is beneficial in preventing type 2 diabetes. Walking, either for recreation or for destination travel, is an inexpensive way to meet physical activity guidelines. Disadvantaged populations with low socioeconomic status (SES) have a higher prevalence of type 2 diabetes and are more likely to live in unwalkable neighborhoods. The purpose of this study was to determine the association between SES and neighborhood walkability in eight Ohio counties with highest prevalence of type 2 diabetes in the state. Using data from the 2010 Ohio Behavioral Risk Factor Surveillance System (BRFSS) survey and walk scores from iPad Walk ScoreTM application, multivariate logistic regression was used to assess the influence of walk score on diabetes prevalence in 5,447 participants (males: 52.4%, females: 47.6%). A Chi-squared test was used to analyze the association between diabetes status and SES. Analysis of Variance (ANOVA) was used to assess association between walk scores income level, and metropolitan statistical area (MSA). An additional walkability score was calculated using a modified version of the Systematic Pedestrian and Cycling Environmental Scan (SPACES) audit instrument. Walk ScoreTM and the SPACES score were compared using Spearman's correlation coefficient. In a multivariate analysis, walk score was not significantly related to diabetes (p = 0.49). Diabetes prevalence was almost twice as high in low SES populations (p > 0.001), and average walk score was highest in the center of the city of a MSA in low SES (p < 0.001). Walkability assessed via SPACES audit was correlated to Walk ScoreTM for destination (p = 0.04), but was not correlated with walking for recreation (p = 0.424). When considering the relationship between SES, neighborhood walkability, and diabetes; the results were varied. Future research should assess walkability using a combination of perceived and objective measures of the built environment.