Abstract
AIMS: This study tested direct and indirect associations between perceived neighborhood social environments and type 2 diabetes (T2D), serially mediated via health-related (physical activity [PA], body mass index [BMI]), psychosocial factors, and inflammation. METHODS: Data came from the Midlife in the United States (MIDUS 3 [2013-2014] and MIDUS 3 Biomarker Project [2017-2022]; n = 518). T2D (yes/no) was based on the American Diabetes Association criteria. Perceived neighborhood social cohesion and safety were assessed separately (higher scores = more favorable neighborhoods). PA, BMI, perceived stress, depression, and c-reactive protein (CRP) were included as mediators in the associations between exposure and the outcome adjusting for covariates. RESULTS: Higher social cohesion was indirectly related to lower likelihood of T2D, serially mediated through PA, BMI, and CRP (odds ratio [OR] = 1.00; 95 % bias-corrected confidence interval [BC CI] = 0.99, 1.00). Higher social cohesion and safety were indirectly associated with a lower likelihood of T2D, serially mediated via stress, depression, and CRP (Social cohesion: OR = 0.98; 95 % BC CI = 0.96, 1.00; and safety: OR = 0.98; 95 % BC CI = 0.96, 1.00, all p < 0.05). CONCLUSIONS: This study may be the first to demonstrate underlying potential mechanisms through which socially cohesive and safe neighborhoods lower the risk of T2D. These pathways present potential targets for interventions to reduce the risk.