Relationship between county-level crime and diabetes: Mediating effect of physical inactivity
McKenzie Hanigan, Michele Heisler, HwaJung Choi
Abstract
This paper assessed the extent to which physical inactivity accounts for the relationship between the crime rate and prevalence of type 2 diabetes in the United States. Using 2018 US county-level data, we compared unadjusted and adjusted prevalence of type 2 diabetes between high and low crime counties for 2,966 US counties. Average causal mediating effects of residents' reported physical inactivity were estimated for each comparison. Counties with a higher crime rate were more likely to have higher percentages of people with type 2 diabetes than counties with a lower crime rate, even after adjusting for potential confounding factors such as racial distribution, income level, food insecurity, and neighborhood walkability (adjusted coefficient for top 40% vs. bottom 40% of crime rate distribution = 0.36; p < 0.001). Over 60% of the adjusted relationship between county-level rate of crime and type 2 diabetes was found to be mediated by physical inactivity. This study reinforces potentially overlooked public health benefits of effective anti-crime measures via improved physical activity.