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Original research
Modifying effect of urban parks on socioeconomic inequalities in diabetes prevalence: a cross-sectional population study of Madrid City, Spain
  1. Elena Plans-Beriso1,2,3,
  2. Pedro Gullon2,
  3. Mario Fontan-Vela2,
  4. Manuel Franco4,
  5. Beatriz Perez-Gomez1,3,
  6. Marina Pollan1,3,
  7. Isabel Cura-Gonzalez5,6,
  8. Usama Bilal7,8
  1. 1Department of Epidemiology of Chronic Diseases, National Center For Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
  2. 2Public Health and Epidemiology Research Group, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcala de Henares, Alcala de Henares, Spain
  3. 3CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
  4. 4Social and Cardiovascular Research Group, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcala de Henares, Alcala de Henares, Spain
  5. 5Primary Care Research Unit, Madrid Health Service, Madrid, Spain
  6. 6Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
  7. 7Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania, USA
  8. 8Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Pedro Gullon, Universidad de Alcala de Henares Facultad de Medicina y Ciencias de la Salud, Alcala de Henares, Spain; pedro.gullon{at}uah.es

Abstract

Background Evidence has shown contradicting results on how the density of urban green spaces may reduce socioeconomic inequalities in type 2 diabetes (equigenic hypothesis). The aim of this study is to test whether socioeconomic inequalities in diabetes prevalence are modified by park density.

Methods We designed a population-wide cross-sectional study of all adults registered in the primary healthcare centres in the city of Madrid, Spain (n=1 305 050). We obtained georeferenced individual-level data from the Primary Care Electronic Health Records, and census-tract level data on socioeconomic status (SES) and park density. We modelled diabetes prevalence using robust Poisson regression models adjusted by age, country of origin, population density and including an interaction term with park density, stratified by gender. We used this model to estimate the Relative Index of Inequality (RII) at different park density levels.

Findings We found an overall RII of 2.90 (95% CI 2.78 to 3.02) and 4.50 (95% CI 4.28 to 4.74) in men and women, respectively, meaning that the prevalence of diabetes was three to four and a half times higher in low SES compared with high SES areas. These inequalities were wider in areas with higher park density for both men and women, with a significant interaction only for women (p=0.008).

Interpretation We found an inverse association between SES and diabetes prevalence in both men and women, with wider inequalities in areas with more parks. Future works should study the mechanisms of these findings, to facilitate the understanding of contextual factors that may mitigate diabetes inequalities.

  • INEQUALITIES
  • DIABETES MELLITUS
  • SOCIAL SCIENCES

Data availability statement

Data may be obtained from a third party and are not publicly available. Data are not publicly available as it contains information from Electronic Medical Records. Upon reasonable request to the Heart Healthy Hoods project, data could be available for researchers.

https://doi.org/10.1136/jech-2023-221198

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. Data are not publicly available as it contains information from Electronic Medical Records. Upon reasonable request to the Heart Healthy Hoods project, data could be available for researchers.

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    Footnotes

    • Twitter @pgullon, @mfranco_uah, @usama_bilal

    • Contributors EP-B and UB conceived the original idea of the study. IC-G, PG, MF-V and MF were responsible for collecting and accessing the data. PG and MF were responsible for the funding. EP-B, BP-G, MP and UB were responsible for the analysis. EP-B, PG and UB wrote the first draft of the manuscript. All authors made substantial contributions to the first draft and approved the final version of the manuscript. Finally, EP-B is the guarantor of the finished work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

    • Funding This project was funded by Instituto de Salud Carlos III, Subdirección General de Evaluación y Fomento de la Investigación, Government of Spain (PI18/00782), and cofunded by the European Union. The funder had no role in the study design, data collection, and analysis, decision to publish, or preparation of the manuscript.

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    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.