Introduction

Type 2 diabetes is one of the non-communicable diseases with higher increasing incidence across the world. Portugal is one of the most affected countries with this increase. Most risk factors for diabetes are modifiable and can be changed by a supportive built environment. The walkability index has been wildly used as concept to describe a healthy built environment. However, the ecological view of health and diabetes identifies the necessity of a multilevel intervention to the creation of a supportive built environment.The goal of this paper is to evaluate the association between walkability indicators and hospital admissions due to diabetes, in the Lisbon Metropolitan Area, by different methods through a proposed ecological model.

Methods

The built environment characteristics were evaluated using walkability measures including density, diversity and design, but also air quality and green areas availability. The socio-economic characteristic was controlled by the most common indicators, but it also included house size and house cost. The diabetes incidence was measured by hospital admissions due to diabetes. The statistical analysis was performed by a path analysis model that allows to consider the complexity of several effects on diabetes.

Results

The results show that built environment influences diabetes through air pollution and active travel. The proposed conceptual model explains 27% of the variance of hospital admissions due to diabetes. Additionally, the mediating variables active travel and air pollution had the variance explained in 73% and 70% respectively.

Conclusions

The results stress the non-direct influence of the built environment in health, showing that health can be improved through the promotion of active travel and the improvement of air quality. The improvement of these aspects is relevant at different levels of intervention, revealing the importance of the civil parishes level. The results reinforce the importance of policies at different levels to effectively change behaviour.

中文翻译：

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里斯本都市区建筑环境与健康之间的关系–步行能力能否解释糖尿病的住院率？

介绍

2型糖尿病是非传染性疾病之一，在世界范围内发病率越来越高。葡萄牙是受影响最大的国家之一。糖尿病的大多数危险因素都是可以改变的，并且可以通过支持性的建筑环境来改变。步行性指数已被广泛用作描述健康建筑环境的概念。但是，从健康和糖尿病的生态学观点出发，需要采取多层次干预措施来营造支撑性的建筑环境。本文的目的是评估里斯本大都会区的步行性指标与糖尿病导致的住院人数之间的关系。 ，通过提出的生态模型通过不同的方法。

方法

建筑物的环境特征通过步行测量来评估，包括密度，多样性和设计，以及空气质量和绿地可用性。社会经济特征受最普遍的指标控制，但也包括房屋面积和房屋成本。糖尿病的发病率是由于糖尿病导致的住院人数来衡量的。通过路径分析模型进行统计分析，该模型可以考虑多种对糖尿病的影响的复杂性。

结果

结果表明，建筑环境通过空气污染和积极出行影响糖尿病。提出的概念模型解释了糖尿病导致的住院人数差异的27％。此外，主动出行和空气污染的中介变量的方差分别解释为73％和70％。

结论

结果强调了建筑环境对健康的非直接影响，表明可以通过促进积极旅行和改善空气质量来改善健康。这些方面的改进在不同级别的干预措施中都具有重要意义，从而揭示了民事教区级别的重要性。结果加强了不同级别的政策对有效改变行为的重要性。