An Empirical Analysis of the Relationship Between Diabetes and Demographic, Socioeconomic and Built Environment Factors Across Turkish Cities

Abstract

Demographic, socioeconomic, and built environment factors of cities are considered among risk factors for many Noncommunicable Diseases (NCDs). Decreasing NCDs and supporting healthy, high-quality urban environments is one of the United Nations’ Sustainable Development Goals (SDGs). In particular, diabetes is related to quality of life and physical activity, making the disease more responsive to built environment factors. This study examines the geographical distribution of diabetes disease rate and its risk factors across Turkish cities. Principal component analysis and spatial regression models are used for this purpose. It is observed that green areas with high accessibility can increase physical activity and thus have a reducing effect on diabetes prevalence. In addition, in cities with sufficient healthcare services per capita, diabetes prevalence is lower. On the other hand, private vehicle ownership can have an increasing effect on diabetes prevalence, and a high share of the elderly population can be another reason for high diagnosis. According to the study findings, planning settlements with high green areas prioritizing green area development, public transportation and non-motorized vehicles, and accessible healthcare facilities can reduce diabetes risk factors by promoting physical activity and increased mobility along with a positive planning and design approach for public health. Elderly-friendly planning specifications need prioritization for some cities. This study presents evidence for the necessity of urban policies and public health strategies prioritizing health and physical activity in urban built environments.

Keywords

• Urban Planning
• Urban Health
• Built Environment
• Spatial Autoregression
• Diabetes

References

1. [1] Institute For Health Metrics And Evaluation, “Global Burden Of Disease Result”, [Online]. Available: Https://Vizhub.Healthdata.Org/Gbd-Results/. [Available:06.11.2023].
2. [2] World Health Organization, “Health Topics”, [Online]. Available: Https://Www.Who.İnt/Health-Topics/Noncommunicable-Diseases#Tab=Tab_1. [Available:06.11.2023].
3. [3] United Nation Turkey, “Sustainable Development Goals”, [Online]. Available: Https://Turkey.Un.Org/En/Sdgs/3. [Available:06.11.2023].
4. [4] T. S. Bakanlığı, “Türkiye Beslenme Ve Sağlık Araştırması (TBSA),” Beslenme Durumu Ve Alışkanlıklarının Değerlendirilmesi Sonuç Raporu Sağlık Bakanl. Yayın, No. 931, 2019.
5. [5] World Health Organization, “WHO Discussion Paper on The Development of an Implementation Roadmap 2023-2030 for The WHO Global Action Plan for The Prevention and Control of Ncds 2023-2030”, WHO, Switzerland,2021.
6. [6] R. A. Defronzo et Al., “Type 2 Diabetes Mellitus,” Nat. Rev. Dis. Primer, vol. 1, no. 1, pp. 1–22, 2015.
7. [7] A. D. Deshpande, M. Harris-Hayes, and M. Schootman, “Epidemiology of Diabetes and Diabetes-Related Complications,” Phys. Ther., vol. 88, no. 11, pp. 1254–1264, 2008.
8. [8] S. Chatterjee, K. Khunti, and M. J. Davies, “Type 2 Diabetes,” The Lancet, vol. 389, no. 10085, pp. 2239–2251, 2017.

9. [9] Y. C. Chooi, C. Ding, and F. Magkos, “The Epidemiology of Obesity,” Metabolism, vol. 92, pp. 6–10, 2019.
10. [10] S. Bakanlığı, “Sağlık İstatistikleri Yıllığı 2017,” 2018, Accessed: Nov. 03, 2023. [Online]. Available: Https://Dspace.Ceid.Org.Tr/Xmlui/Handle/1/1561
11. [11] T. Dendup, X. Feng, S. Clingan, and T. Astell-Burt, “Environmental Risk Factors For Developing Type 2 Diabetes Mellitus: A Systematic Review,” Int. J. Environ. Res. Public. Health, vol. 15, no. 1, p. 78, 2018.
12. [12] G. Seravalle and G. Grassi, “Obesity And Hypertension,” Pharmacol. Res., vol. 122, pp. 1–7, 2017.
13. [13] L. Chen, D. J. Magliano, and P. Z. Zimmet, “The Worldwide Epidemiology of Type 2 Diabetes Mellitus—Present and Future Perspectives,” Nat. Rev. Endocrinol., vol. 8, no. 4, pp. 228–236, 2012.
14. [14] A. B. Olokoba, O. A. Obateru, and L. B. Olokoba, “Type 2 Diabetes Mellitus: A Review Of Current Trends,” Oman Med. J., vol. 27, no. 4, p. 269, 2012.
15. [15] B. Fletcher, M. Gulanick, and C. Lamendola, “Risk Factors for Type 2 Diabetes Mellitus,” J. Cardiovasc. Nurs., vol. 16, no. 2, pp. 17–23, 2002.
16. [16] R. Ewing, G. Meakins, S. Hamidi, and A. C. Nelson, “Relationship Between Urban Sprawl and Physical Activity, Obesity, And Morbidity–Update and Refinement,” Health Place, vol. 26, pp. 118–126, 2014.
17. [17] D. Thomas, E. J. Elliott, and G. A. Naughton, “Exercise For Type 2 Diabetes Mellitus,” Cochrane Database Syst. Rev., no. 3, 2006, Accessed: Nov. 03, 2023. [Online]. Available: Https://Www.Cochranelibrary.Com/Cdsr/Doi/10.1002/14651858.CD002968.Pub2/Abstract
18. [18] G. Lastra, S. Syed, L. R. Kurukulasuriya, C. Manrique, and J. R. Sowers, “Type 2 Diabetes Mellitus and Hypertension: an Update,” Endocrinol. Metab. Clin., vol. 43, no. 1, pp. 103–122, 2014.
19. [19] S. Rajagopalan and R. D. Brook, “Air Pollution and Type 2 Diabetes: Mechanistic İnsights,” Diabetes, vol. 61, no. 12, pp. 3037–3045, 2012.
20. [20] V. S. Malik, W. C. Willett, and F. B. Hu, “Global Obesity: Trends, Risk Factors and Policy İmplications,” Nat. Rev. Endocrinol., vol. 9, no. 1, pp. 13–27, 2013.
21. [21] P. L. Valenzuela, P. Carrera-Bastos, A. Castillo-García, D. E. Lieberman, A. Santos-Lozano, and A. Lucia, “Obesity and The Risk of Cardiometabolic Diseases,” Nat. Rev. Cardiol., pp. 1–20, 2023.
22. [22] C. Sarkar, C. Webster, and J. Gallacher, "Residential Density and Adiposity: Findings From The UK Biobank," Lancet, vol. 390, Nn. Supplement 3, 2017.
23. [23] J. Feng, T. A. Glass, F. C. Curriero, W. F. Stewart, and B. S. Schwartz, "The Built Environment and Obesity: A Systematic Review of The Epidemiologic Evidence," Health & Place, vol. 16, no. 2, pp. 175-190, 2010.
24. [24] N. R. Den Braver, J. Lakerveld, F. Rutters, L. J. Schoonmade, J. Brug, And J. W. J. Beulens, “Built Environmental Characteristics and Diabetes: A Systematic Review And Meta-Analysis,” BMC Med., vol. 16, no. 1, p. 12, Dec. 2018, Doi: 10.1186/S12916-017-0997-Z.
25. [25] M. Neuvonen, T. Sievänen, S. Tönnes, and T. Koskela, "Access to Green Areas and the Frequency of Visits–a Case Study in Helsinki," Urban Forestry & Urban Greening, vol. 6, no. 4, pp. 235-247, 2007.
26. [26] F. De La Fuente et al., "Green Space Exposure Association with Type 2 Diabetes Mellitus, Physical Activity, and Obesity: A Systematic Review," International Journal of Environmental Research and Public Health, vol. 18, no. 1, p. 97, 2021.
27. [27] C. P. Durand, M. Andalib, G. F. Dunton, J. Wolch, And M. A. Pentz, “A Systematic Review of Built Environment Factors Related to Physical Activity and Obesity Risk: Implications for Smart Growth Urban Planning,” Obes. Rev., vol. 12, no. 5, May 2011, Doi: 10.1111/J.1467-789X.2010.00826.X.
28. [28] J. D. Mackenbach Et Al., “Obesogenic Environments: A Systematic Review Of The Association Between The Physical Environment and Adult Weight Status, The SPOTLIGHT Project,” BMC Public Health, vol. 14, no. 1, p. 233, Dec. 2014, Doi: 10.1186/1471-2458-14-233.
29. [29] U. Bilal, A. H. Auchincloss, And A. V. Diez-Roux, “Neighborhood Environments And Diabetes Risk and Control,” Curr. Diab. Rep., vol. 18, no. 9, p. 62, Sep. 2018, Doi: 10.1007/S11892-018-1032-2.
30. [30] J. F. Sallis, E. Cerin, T.L. Conway, M.A. Adams, L.D. Frank, M. Pratt And N. Owen, “Physical Activity in Relation to Urban Environments in 14 Cities Worldwide: A Cross-Sectional Study”, The Lancet, vol.387, no.10034, pp. 2207-2217, 2016.
31. [31] T. Honda, V. C. Pun, J. Manjourides And H. Suh, “Associations Between Long-Term Exposure To Air Pollution, Glycosylated Hemoglobin And Diabetes”, International Journal of Hygiene and Environmental Health, vol. 220, no.7, pp. 1124-1132, 2017.
32. [32] M. Strak, N. Janssen, R. Beelen, O. Schmitz, I. Vaartjes, D. Karssenberg And G. Hoek, “Long-Term Exposure To Particulate Matter, NO2 And The Oxidative Potential Of Particulates And Diabetes Prevalence in a Large National Health Survey”. Environment International, vol. 108, pp. 228-236, 2017.
33. [33] H. Qiu, C. M. Schooling, S. Sun, H. Tsang, Y. Yang, R. S. Lee, And L. Tian, “Long-Term Exposure To Fine Particulate Matter Air Pollution and Type 2 Diabetes Mellitus in Elderly: A Cohort Study in Hong Kong”, Environment International, vol.113, pp. 350-356, 2018.
34. [34] G. R. Aarthi, T. S. M.Begum, S.Al Moosawi, D.Kusuma, H.Ranjani, R. Paradeepa, And D. Fecht, “Associations of The Built Environment with Type 2 Diabetes in Asia: A Systematic Review”, BMJ Open, vol.13, no.4, p. E065431, 2023.
35. [35] O. Raaschou-Nielsen Et Al., “Long-Term Exposure To Traffic-Related Air Pollution and Diabetes-Associated Mortality: A Cohort Study,” Diabetologia, Aug. 2012, Doi: 10.1007/S00125-012-2698-7.
36. [36] Ministry Of Health, “National Household Health Survey İn Turkey: Prevalence of Noncommunicable Disease Risk Factors, 2017 Final Report”, World Health Organization, WHO, Ankara, 2017. Https://İris.Who.İnt/Handle/10665/342200
37. [37] T. S. Bakanlığı, Türkiye Bulaşıcı Olmayan Hastalıklar Ve Risk Faktörleri Kohort Çalışması Sağlık Bakanl. Yayın, No. 1206, 2021.
38. [38] United Nation, “Basic Data Selection”, [Online]. Available: Https://Unstats.Un.Org/Unsd/Snaama/Basic [Available:06.11.2023].
39. [39] R. Dubin, K. Pace, and T. Thibodeau, “Spatial Autoregression Techniques For Real Estate Data,” J. Real Estate Lit., vol. 7, no. 1, pp. 79–95, Jan. 1999, Doi: 10.1080/10835547.1999.12090079.
40. [40] B. H. Ozuduru, “Assessment of Spatial Dependence Using Spatial Autoregression Models: Empirical Analysis of Shopping Center Space Supply in Ohio,” J. Urban Plan. Dev., vol. 139, no. 1, pp. 12–21, Mar. 2013, Doi: 10.1061/(ASCE)UP.1943-5444.0000129.
41. [41] Anselin, L. “Local Indicators of Spatial Association—LISA”. Geographical Analysis, vol. 27, no. 2, pp. 93-115, 1995.
42. [42] L. C. Messer Et Al., “The Development Of A Standardized Neighborhood Deprivation Index,” J. Urban Health, Vol. 83, No. 6, pp. 1041–1062, Dec. 2006, Doi: 10.1007/S11524-006-9094-X.
43. [43] M. Greenacre, P. J. Groenen, T. Hastie, A. I. d’Enza, A. Markos, And E. Tuzhilina, “Principal Component Analysis,” Nat. Rev. Methods Primer, vol. 2, no. 1, p. 100, 2022.
44. [44] C. Fang, H. Liu, G. Li, D. Sun, and Z. Miao, "Estimating The İmpact Of Urbanization on Air Quality in China Using Spatial Regression Models," Sustainability, vol. 7, no. 11, Pp. 15570–15592, 2015.
45. [45] Ö. Çokluk, G. Şekercioğlu Ve Ş. Büyüköztürk, Ş, Sosyal Bilimler İçin Çok Değişkenli İstatistik: SPSS Ve Lisrel Uygulamaları, Vadi Grup Basım A.Ş, Ankara, Pegem Akademi Yayıncılık, 2021.
46. [46] Y. D. D. Ş. Büyüköztürk , "Faktör Analizi: Temel Kavramlar Ve Ölçek Geliştirmede Kullanımı", Kuram Ve Uygulamada Eğitim Yönetimi, vol. 32, no. 32, Pp. 470-483, Mar. 2002
47. [47] R. I. G. Holt, M. De Groot, and S. H. Golden, “Diabetes And Depression,” Curr. Diab. Rep., vol. 14, no. 6, p. 491, Jun. 2014, Doi: 10.1007/S11892-014-0491-3.
48. [48] A. Trikkalinou, A. K. Papazafiropoulou, And A. Melidonis, “Type 2 Diabetes And Quality of Life,” World J. Diabetes, vol. 8, no. 4, p. 120, 2017.
49. [49] E. Agardh, P. Allebeck, J. Hallqvist, T. Moradi, And A. Sidorchuk, “Type 2 Diabetes İncidence And Socio-Economic Position: A Systematic Review And Meta-Analysis,” Int. J. Epidemiol., vol. 40, no. 3, pp. 804–818, 2011.
50. [50] M. Schetz et al., "Obesity İn The Critically İll: A Narrative Review," Intensive Care Med., vol. 45, no. 6, pp. 757–769, Jun. 2019, Doi: 10.1007/S00134-019-05594-1.
51. [51] World Health Organization, “What Are The WHO Air Quality Guidelines?”, [Online]. Available: Https://Www.Who.İnt/News-Room/Feature-Stories/Detail/What-Are-The-Who-Air-Quality-Guidelines. [Available:06.11.2023].
52. [52] S. L. Handy, M. G. Boarnet, R. Ewing, and R. E. Killingsworth, "How the built environment affects physical activity: views from urban planning," American journal of preventive medicine, vol. 23, no. 2, pp. 64-73, 2002.
53. [53] M. Carmona, "Residential design policy and guidance: content, analytical basis, prescription and regional emphasis," Planning Practice and Research, vol. 14, no. 1, pp. 17-38, 1999.
54. [54] The Ministry of Environment, Urbanism, and Climate Change, “3194 Law on Land Development Planning and Control”, [Online]. Available: https://webdosya.csb.gov.tr/db/mpgm/icerikler/ek-2-tablo-17-mayis-20180214143000.pdf . [Available:24.11.2023].