Salutogenic effects of living near aquatic areas (blue space) remain underexplored, particularly in non-coastal and non-urban areas. We evaluated associations of residential proximity to inland freshwater blue space with new onset type 2 diabetes (T2D) in central and northeast Pennsylvania, USA, using medical records to conduct a nested case-control study. T2D cases (n = 15,888) were identified from diabetes diagnoses, medication orders, and laboratory test results and frequency-matched on age, sex, and encounter year to diabetes-free controls (n = 79,435). We calculated distance from individual residences to the nearest lake, river, tributary, or large stream, and residence within the 100-year floodplain. Logistic regression models adjusted for community socioeconomic deprivation and other confounding variables and stratified by community type (townships [rural/suburban], boroughs [small towns], city census tracts). Compared to individuals living ≥ 1.25 miles from blue space, those within 0.25 miles had 8% and 17% higher odds of T2D onset in townships and boroughs, respectively. Among city residents, T2D odds were 38–39% higher for those living 0.25 to < 0.75 miles from blue space. Residing within the floodplain was associated with 16% and 14% higher T2D odds in townships and boroughs. A post-hoc analysis demonstrated patterns of lower residential property values with nearer distance to the region’s predominant waterbody, suggesting unmeasured confounding by socioeconomic disadvantage. This may explain our unexpected findings of higher T2D odds with closer proximity to blue space. Our findings highlight the importance of historic and economic context and interrelated factors such as flood risk and lack of waterfront development in blue space research.

生活在水生区域（蓝色空间）附近的有益健康影响仍未得到充分探索，特别是在非沿海和非城市地区。我们使用医疗记录进行巢式病例对照研究，评估了美国宾夕法尼亚州中部和东北部住宅靠近内陆淡水蓝色空间与新发 2 型糖尿病 (T2D) 的关联。T2D 病例 (n = 15,888) 是从糖尿病诊断、用药医嘱和实验室检查结果中确定的，并在年龄、性别和遭遇年份与无糖尿病对照组 (n = 79,435) 上进行频率匹配。我们计算了从单个住宅到最近的湖泊、河流、支流或大溪流的距离，以及 100 年洪泛区内的住宅。逻辑回归模型针对社区社会经济剥夺和其他混杂变量进行了调整，并按社区类型（乡镇[农村/郊区]、自治市镇[小城镇]、城市人口普查区）分层。与居住在距离蓝色空间≥ 1.25 英里的人相比，那些在 0.25 英里范围内的人在乡镇和行政区中 T2D 发病的几率分别高出 8% 和 17%。在城市居民中，距离蓝色空间 0.25 到 < 0.75 英里的人患 T2D 的几率要高 38-39%。居住在洪泛区与乡镇和行政区的 T2D 几率分别增加 16% 和 14%。事后分析表明，住宅物业价值较低的模式与该地区主要水体的距离较近，这表明社会经济劣势造成了无法衡量的混杂。这可以解释我们出人意料的发现，即更接近蓝色空间的 T2D 几率更高。我们的研究结果强调了历史和经济背景以及相互关联的因素（例如洪水风险和缺乏滨水区开发）在蓝色空间研究中的重要性。