Abstract
<jats:p><p dir="ltr"><b>Objective: </b>Neighborhood walkability is associated with lower gestational diabetes (GDM) risk, but its association with type 2 diabetes after GDM is unknown. We estimated this association and assessed effect modification by individual and neighborhood socioeconomic conditions.</p><p dir="ltr"><b>Research Design and Methods: </b>Women with GDM who delivered in New York City (NYC) in 2009-2011 were identified through birth certificated/hospital discharge and linked to NYC A1C Registry data (2009-2021) for follow-up. Women with pre-pregnancy diabetes were excluded. A previously published neighborhood walkability index was categorized into quartiles. Type 2 diabetes was ascertained as two A1C results ≥6.5% (48 mmol/mol) after 12 weeks postpartum. Cox proportional hazards models estimated associations between walkability and type 2 diabetes after GDM, adjusting for individual- and neighborhood-level characteristics. Stratification analyses were conducted by socioeconomic conditions.</p><p dir="ltr"><b>Results: </b>Among N=12,403 women with GDM at baseline, the 12-year cumulative incidence of type 2 diabetes was 20.6%. Adjusted hazard ratios of type 2 diabetes for low-medium (aHR=0.89, 95% CI 0.76, 1.04), medium (aHR=0.85, 95% CI 0.74, 0.99), and high (aHR=0.88, 95% CI 0.76, 1.03) walkability (vs low) were protective or null. The protective association from high walkability was observed only in the most affluent neighborhoods (aHR=0.52, 95% CI 0.31, 0.89).</p><p dir="ltr"><b>Conclusions: </b>In NYC, more walkable neighborhoods were associated with lower risk of type 2 diabetes after GDM without a dose-response effect, and associations depended on individual and neighborhood socioeconomic contexts. While increasing walkability is a core planning goal and may improve health, decisions should also address neighborhood inequities in diabetes.</p></jats:p>