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Role of perceived neighbourhood crime in the longitudinal association between perceived built environment and type 2 diabetes mellitus: a moderated mediation analysis
  1. Tashi Dendup1,
  2. Xiaoqi Feng1,2,3,4,
  3. P. Y. O’Shaughnessy5,
  4. Thomas Astell-Burt1,3,4,6
  1. 1 Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
  2. 2 School of Population Health, University of New South Wales, Sydney, NSW, Australia
  3. 3 Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, NSW, Australia
  4. 4 National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
  5. 5 School of Mathematics and Applied Statistics, University of Wollongong, Wollongong, NSW, Australia
  6. 6 School of Public Health, Peking Union Medical College and The Chinese Academy of Medical Sciences, Beijing, China
  1. Correspondence to Thomas Astell-Burt, Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, University of Wollongong, Wollongong, NSW, Australia; thomasab{at}


Background We examined to what extent perceived neighbourhood crime moderates, associations between type 2 diabetes mellitus (T2DM) and perceived local amenities, recreational facilities, footpaths and public transit, and potential mediation of environmental characteristics—T2DM association by physical activity, social contact, sleep and body mass index (BMI).

Methods The 45 and Up Study data of 36, 224 individuals collected from 2010 to 2015 were analysed in 2019 using multilevel logistic regression to examine the association between T2DM and clustering of unfavourable built environment, and any difference in the association with increasing unfavourable environment and area disadvantage. We performed causal mediation analyses stratified by crime to examine whether crime moderated the strength of identified local amenities–T2DM pathways.

Results The results showed that irrespective of crime, perceived lack of local amenities was associated with increased odds of developing T2DM, and BMI mediated 40% and 30.3% of this association among those who reported unsafe and safe daytime crime, respectively. The proportion mediated by BMI among those who reported unsafe and safe night-time crime was 27.3% and 35.1%, respectively. Walking mediated 5.7% of the local amenities–T2DM association among those who reported safe daytime crime. The odds of T2DM increased with rising unfavourable environment and area disadvantage.

Conclusions The results suggest that the availability of neighbourhood amenities may lower T2DM risk by increasing walking and reducing BMI regardless of area crime. Policies to enhance access to local amenities and prevent crime, especially in disadvantaged areas, may support healthy behaviour and physical health that can potentially reduce T2DM risk.

  • Control of diseases
  • Diabetes
  • Environmental epidemiology
  • Longitudinal studies
  • Prevention

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  • Contributors TD designed the study, analysed and interpreted the data, and prepared and revised the manuscript. XF, TAB and PYƠS supervised and directed the conduct of the study including study design and data interpretation, and critically reviewed the draft manuscript for intellectual content. XF and TAB secured data and funding for this study. All authors read and approved the final draft manuscript.

  • Funding This work was supported by project-grant funding from the National Health and Medical Research Council (grant no. 1101065 led by TAB and XF), and fellowship funding from the National Heart Foundation of Australia (grant no. 100948, XF) and the National Health and Medical Research Council (grant no. 1140317, TAB).

  • Disclaimer All aspects related to the conduct of this study including the views stated and the decision to publish the findings are that of the authors only.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The University of New South Wales Human Research Ethics Committee granted the ethical approval for the 45 and Up Study, and the University of Wollongong Human Research Ethics Committee provided ethical approval (No: 2016/158) for the current study.

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

  • Data availability statement Data may be obtained from a third party and are not publicly available.

  • 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.