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Car-centric neighbourhoods drive up rates of diabetes


People living in neighbourhoods with the highest drivability score have a 41% greater risk of developing diabetes, according to a new study from ICES and Unity Health Toronto.

The researchers also found that younger adults living in car-dependent neighbourhoods had an almost two-fold increased risk of developing diabetes, compared to those living in the least drivable neighbourhoods. 

The study, published in Diabetes Care, examined the association between neighbourhood drivability—the characteristics of the built environment related to car use—and rates of diabetes in Toronto, Canada, one of the largest cities in North America. To date, no studies have investigated the link between neighbourhood drivability and the risk of developing diabetes in different age groups.

“Encouraging people to take public transit or walk to work isn't all that beneficial when the built environment doesn't support these activities," says lead author Nicole den Braver, a postdoctoral researcher at the Amsterdam University Medical Centres. “In this study, we examined the role of the built environment in early prevention of diabetes, and whether certain age groups are affected differently.” 

Using administrative health data from ICES, the cohort study included almost one-and-a-half million working-aged adults (20 to 64 years) without diabetes in 2011 and followed them for seven years. Neighbourhood drivability was divided into five groups, from lowest (least car-dependent) to highest (most car-dependent).

The data showed that:

  • Those living in the most drivable neighbourhoods had a 41% greater risk of developing diabetes.
  • Younger individuals (20 to 34 years) living in the most car-dependent neighbourhoods and who were middle-income had an almost two-fold risk of developing diabetes, compared to the least car-dependent neighbourhoods.
  • The highest risk for diabetes was found when high drivability co-occurred with low walkability scores. This suggests that to prevent diabetes, not only should car use be discouraged, but at the same time, walking should be facilitated.

This is an observational study, so cause and effect can’t be established, and the researchers acknowledge several limitations, including the assumption that drivability would remain stable over time, the focus on residential areas only, and other social determinants of health that may have explained higher rates of diabetes in certain neighbourhoods.

Nevertheless, they say that their findings provide unique insights into the field of transport and diabetes risk. The strengths of the study include a large population followed over time, and the novel use of both drivability and walkability scores.

"Our study suggests that urban developers and municipalities have an opportunity to enhance diabetes prevention, by designing neighbourhoods that encourage active transportation and discourage car use,” says senior author Gillian Booth, a practising endocrinologist and scientist with ICES and MAP Centre for Urban Health Solutions, housed at St. Michael’s Hospital, a site of Unity Health Toronto. “This may be especially helpful for younger adults, as physical activity is critical for preventing earlier stages (prediabetes) from progressing to diabetes and can even reverse this process.”

Research into the impact of the built environment on diabetes rates is important for addressing the rise in diagnoses around the world. As a visiting research fellow in Toronto (supported by the European Foundation for the Study of Diabetes and the Amsterdam Public Health Research Institute), Dr. den Braver also led a previous project which observed that the impact of drivability was greatest for shorter trips (less than 3 kilometres), for which walking or cycling is a feasible alternative. Also, the drivability of an individual’s workplace destination was an important determinant for car commuters.

For the next step, Dr. den Braver and the EXPOSOME-NL consortium—a group of over 50 international scientists examining the impact of environmental factors on health—will be working on translating the drivability index to a Dutch context. The authors are also working on strategies to engage with Canadian decision-makers to translate this research into policy.

The study, “Higher neighbourhood drivability is associated with a higher diabetes risk in younger adults: a population-based cohort study in Toronto, Canada” was published in Diabetes Care.

Author block: den Braver NR, Beulens JWJ, Wu CF, Fazli GS, Gozdyra P, Howell NA, Lakerveld J, Moin JS, Rutters F, Brug J, Moineddin R, Booth GL.

ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario

About St. Michael's 

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future healthcare professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About Unity Health Toronto

Unity Health Toronto, comprised of St. Joseph’s Health Centre, St. Michael’s Hospital and Providence Healthcare, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit www.unityhealth.to.


Misty Pratt
Senior Communications Officer, ICES
[email protected]

Communications and Public Affairs, Unity Health Toronto 
[email protected]


Contributing ICES Scientists

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