The Association between Unhealthy Food Environments and Outcomes of Type 2 Diabetes Care in Flanders, Belgium
Although research increasingly highlights the impact of food environments on health, studies linking environmental characteristics to outcomes of type 2 diabetes (T2D) care remain scarce. This study examines the association between the retail food environment and HbA1c levels in a cohort of T2D patients in Flanders, Belgium.
Data & methods
We used a unique longitudinal database covering a three-year retrospective follow-up of 4.189 T2D patients aged 40+ treated in primary care practices across three regions in Flanders. The dataset combines (a) health insurance data, (b) medical lab data on HbA1c test results, and (c) information on the socioeconomic and food environment at the level of the census tract of patients’ place of residence. Food environments were mapped using the Locatus database, providing addresses of all food retailers in Flanders. For each census tract, we counted the total number of unhealthy food outlets within a 500m walking distance from each address and, subsequently, averaged it across the number of addresses within the tract.
Using linear mixed models with repeated measurements nested within patients, in turn, nested within census tracts, we assessed the association between the average number of unhealthy food options within walking distance of T2D patients’ place of residence and their HbA1c levels.
Preliminary results
Controlling for individual covariates, patients living in areas with more unhealthy food options within walking distance had, on average, higher HbA1c levels. This relationship, however, depended on the urbanization level and median household income of the census tract. Two- and three-way interactions showed that the association between unhealthy food environment and HbA1c levels held only for those living in the poorest 20% neighbourhoods of urban cities.
Preliminary conclusion
Our preliminary results suggest a clustering of the adverse impact of an unhealthy food environment on blood glucose levels in the poorest neighbourhoods of urban cities.