Abstract Body (Do not enter title and authors here): Background: While green space exposure has been linked to improved cardiometabolic outcomes, the relationship between actual green space visitation and incident type 2 diabetes mellitus (T2DM) risk remains poorly defined. Population mobility data capturing neighborhood-level visitation patterns offer a novel approach to quantifying green space use. Using mobility-derived green space visitation data, we evaluated the association between neighborhood green space use and T2DM in a large U.S. healthcare system cohort.
Methods: We identified adults (≥18 years) without baseline T2DM using the Houston Methodist Learning Health System Registry between 2016 and 2023. Annual green space visits per capita at the census tract level were derived from Advan Patterns mobility data for the year 2021 and linked to patient addresses. Incident T2DM was defined using diagnostic codes, diabetes medication prescriptions, or hemoglobin A1c ≥6.5% occurring after baseline. Cox proportional hazards models estimated associations between green space visitation and incident T2DM, using both quartile-based comparisons (Q4 vs Q1) and continuous models (per 10 visits), adjusted sequentially for demographics, insurance status, cardiometabolic risk factors, the CDC Social Vulnerability Index, and annual PM2.5 exposure.
Results: Among 1,003,526 patients followed over 2.1 million person-years, 40,152 developed T2DM, yielding an overall incidence rate of 1.88 per 100 person-years. In quartile-based analysis, individuals in the highest quartile (Q4) of green space visits had a 21% lower risk of incident T2DM compared to the lowest quartile (Q1) after full adjustment (95% CI: 0.754–0.837; p<0.001) (Figure). In continuous models, every 10 additional green space visits per year was associated with a 10.7% lower risk of T2DM (95% CI: 0.874–0.913]; p<0.001).
Conclusion: Greater green space visitation is associated with a lower risk of developing T2DM. These findings highlight the potential of green space use as a modifiable environmental factor in T2DM prevention. Promoting equitable access to green environments may represent a scalable public health strategy to reduce diabetes risk and advance environmental health equity through urban planning and community-based interventions.