Association between Neighborhood Environment and Quality of Sleep in Older Adult Residents Living in Japan: The JAGES 2010 Cross-Sectional Study

Impact of living environment on sleep quality in older adults and the mediating role of depression: a cross-sectional study

Sleep quality significantly affects the well-being of older adults. This study aimed to analyse the current state of sleep quality among older adults in China and to examine the effects of living environment and depression on sleep quality, as well as their interrelationship(s). A survey was conducted using a self-designed questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and Patient Health Questionnaire Depression Scale (PHQ-9), targeting a sample of adults ≥ 60 years of age in the central province of China, yielding 6211 valid responses. Correlation analysis indicated that the living environment was negatively correlated with both depression and PSQI score (r = - 0.140, p < 0.01; r = - 0.174, p < 0.01). The living environment (β = - 0.049, p < 0.001) was a negative predictor of PSQI, while depression (β = 0.477, p < 0.001) was a positive predictor. Mediation analysis revealed that depression acted as a mediator between the living environment and sleep quality, contributing 61.7% of the overall effect. Further analysis through hierarchical regression and simple slope plotting indicated that in a favourable living environment, the impact of depression on sleep quality was more pronounced. These findings suggest that a supportive living environment has a protective effect against poor sleep hygiene among older adults and that depression plays a significant mediating role. Intervention strategies should focus on improving living environments and implementing mental health measures to enhance sleep quality among older adults.

The prevalence and risk factors of sleep disturbances in community-dwelling older adults: a systematic review and meta-analysis

PURPOSE

Sleep disturbance is one of the most prevalent health issues among community-dwelling older adults. This systematic review aims to assess the prevalence of sleep disturbances among these adults living in the community and identify associated risk factors.

METHODS

A comprehensive literature search was performed using PubMed, Web of Science, Embase, and the Cochrane Library databases. We screened studies focusing on the prevalence of sleep disturbances in community-dwelling older adults (≥ 60 years). A random-effects model was used to calculate the pooled prevalence of sleep disturbances. Sensitivity and subgroup analyses were conducted to investigate sources of heterogeneity, and funnel plots were used to assess publication bias.

RESULTS

Our systematic review included 41 articles, encompassing a total sample of 71,607 participants from 13 countries. The pooled prevalence of sleep disturbances, measured by PSQI, was found to be 45% (95% CI: 40-50%). Notably, the prevalence of sleep disturbances was significantly higher among individuals aged 70 years and older (48%) compared to those aged 60 years and older (41%). Common risk factors for sleep disturbances included depression, advanced age, females, chronic diseases (hypertension, coronary heart disease, chronic obstructive pulmonary disease) and poor external support (poor social support and poor family relationships).

CONCLUSION

The findings highlight the necessity for comprehensive assessments and management strategies targeting this population with depression, advanced age, females, hypertension, coronary heart disease, chronic obstructive pulmonary disease, and poor external support while also underscoring the significance of healthcare planners and policymakers in enhancing sleep quality for older adults.

Prediction of physiological status, community participation, and daily activity function to sleep quality for outpatient dynapenic older people

BACKGROUND

The global aging population has increased dynapenia prevalence, leading to mobility issues and poor sleep quality among older adults. Despite its impact, research on sleep quality in dynapenic outpatients is limited. This study investigates how physiological status, community participation, and daily activity function influence sleep quality in this group.

METHODS

This cross-sectional study employed purposive sampling to collect data from 192 dynapenic older outpatients in October 2022, assessing their basic attributes, physiological status, community participation, daily activity function, and sleep quality. Data were analyzed using SPSS 25.0 for descriptive statistics, independent samples t-tests, chi-square tests, and logistic regression analysis.

RESULTS

Findings indicated significant correlations between sleep quality and gender (X2 = 11.340, p < .001), occupational status (X2 = 13.378, p < .05), residence (X2 = 6.265, p < .05), medication intake (X2 = 7.250, p < .05), smoking history (X2 = 6.695, p < .01), instrumental activities of daily living (X2 = 12.556, p < .01), activities of daily living (t = 2.74, p < .01), instrumental activities of daily living (t = 3.60, p < .001), skeletal muscle mass (t = 2.94, p < .01), skeletal muscle index (t = 2.65, p < .01), grip strength (t = 3.61, p < .001), and walking speed (t = 2.09, p < .05). Furthermore, the type of occupational status (OR = 6.608, 95% CI = 1.124-3.744, p < .05), medication intake (OR = 3.916, 95% CI = 1.682-9.114, p < .05), and grip strength (OR = 0.891, 95% CI = 0.797-0.996, p < .05) were significant predictors of sleep quality in dynapenic older patients.

CONCLUSION

This cross-sectional study reveals significant correlations between sleep quality and key factors such as physiological status, community participation, and daily functional activities in older adults with dynapenia. These findings underscore the importance of addressing these determinants to enhance sleep quality in this population.

Disadvantaged social status contributed to sleep disorders: An observational and genome-wide gene-environment interaction analysis

BACKGROUND

Sleep is a natural and essential physiological need for individuals. Our study aimed to research the associations between accumulated social risks and sleep disorders.

METHODS

In this study, we came up with a polysocial risk score (PsRS), which is a cumulative social risk index composed of 13 social determinants of health. This research includes 239,165 individuals with sleep disorders and social determinants of health data from the UK Biobank cohort. First, logistic regression models were performed to examine the associations of social determinants of health and sleep disorders, including chronotype, narcolepsy, insomnia, snoring, short and long sleep duration. Then, PsRS was calculated based on statistically significant social determinants of health for each sleep disorder. Third, a genome-wide gene-environment interaction study was conducted to explore the interactions between single-nucleotide polymorphisms and PsRS in relation to sleep disorders.

RESULTS

Higher PsRS scores were associated with worse sleep status, with the adjusted odds ratio (OR) ranging from 1.10 (95% Confidence interval [CI]: 1.09-1.11) to 1.29 (95% CI: 1.27-1.30) for sleep disorders. Emotional stress (OR = 1.36, 95% CI: 1.28-1.43) and not in paid employment (OR = 2.62, 95% CI: 2.51-2.74) were found to have significant contributions for sleep disorders. Moreover, multiple single-nucleotide polymorphisms were discovered to have interactions with PsRS, such as FRAS1 (P = 2.57 × 10-14) and CACNA1A (P = 8.62 × 10-14) for narcolepsy, and ACKR3 (P = 1.24 × 10-8) for long sleep.

CONCLUSIONS

Our findings suggested that cumulative social risks was associated with sleep disorders, while the interactions between genetic susceptibility and disadvantaged social status are risk factors for the development of sleep disorders.

Neighborhood Environments and Healthy Life Expectancy in Older Adults: A 6-year Longitudinal Cohort Study Based on Data from the Japan Gerontological Evaluation Study

Introduction

A well-established association exists between health and neighborhood land use patterns, including parks, roads, and other physical environments, also called the built environment. Previous studies have demonstrated that the built environment influences health, particularly among older populations, because the scope of activities in such populations is limited. Herein, we investigated the association between specific neighborhood environments and the healthy life expectancy of older individuals.

Methods

Data at two time points (2013 and 2019) from the Japan Gerontological Evaluation Study were used in this study. The study comprised a sample of 8,956 residents aged ≥65 years who were not certified for long-term care. Information on the presence or absence of eight types of neighborhood environments was collected using a questionnaire. A multistate life table analysis was conducted to determine the association between perceived neighborhood environments and healthy life expectancy.

Results

Significant differences were observed in the "parks and sidewalks suitable for exercise and walking" category. The group that perceived "parks and sidewalks suitable for exercise and walking" had an approximately 1.2-year longer healthy life expectancy than the group that did not perceive such parks and sidewalks. In addition, individuals who lived within walking distance of a park were more physically active than those who did not.

Conclusions

Safe, walkable neighborhoods with excellent parks may encourage physical activity among older adults and extend their healthy lifespan. Future research is warranted to identify the underlying mechanisms.

Association between sleep quality and living environment among Chinese older persons: a cross-sectional study

Sleep quality significantly affects the quality of life of older persons. Therefore, this study explored the relationship between sleep quality and living environment of older persons in China to provide a theoretical basis for therapies to alleviate sleep disorders in older persons. A total of 6211 subjects > 60 years of age in Anhui Province, China, were evaluated using the Pittsburgh Sleep Quality Index and a self-reported questionnaire. Multivariate logistic regression analysis revealed that living alone (OR = 1.26, 95% CI 1.09-1.46) and living in a rural area (OR = 1.19, 95% CI 1.06-1.34) were significantly associated with a high incidence of sleep disorders in older persons. Living near a park or foot paths suitable for exercise or walking was significantly associated with a lower incidence of sleep disorders in older persons (OR = 0.87, 95% CI 0.77-0.96). Individual factors such as female sex (OR = 1.30, 95% CI 1.14-1.48) and depression (OR = 2.80, 95% CI 2.47-3.19) were also associated with sleep quality in older persons. These data indicate a correlation exists between living environment and sleep quality.

Worldwide prevalence of sleep problems in community-dwelling older adults: A systematic review and meta-analysis

The understanding of the prevalence of sleep problems in older adults can provide a broad and reliable perspective into the occurrence of such issues among older adults. This systematic review and meta-analysis aimed to estimate the worldwide prevalence of sleep problems in community-dwelling older adults. Studies that provide information on the prevalence of sleep problems in community-dwelling older adults (≥60 years) were screened between December 2022 and March 2023. A total of 20,379 studies were identified in database searches, from which 252 were included in this review. These studies covered the last 35 years (from 1988 to 2023) and pooled a sample of 995,544 participants from 36 countries. The most frequent sleep problem worldwide was obstructive sleep apnea (46.0%), followed by poor sleep quality (40.0%), other sleep problems (37.0%), insomnia (29.0%), and excessive daytime sleepiness (19.0%). No significant difference in the prevalence estimates of all sleep problems was observed between the sexes. This systematic review and meta-analysis showed a high prevalence of some sleep problems, mainly obstructive sleep apnea, poor sleep quality, and other sleep problems. Our estimates can be useful for managers and policymakers in planning healthcare strategies for sleep problems aimed at the older population.

Perceived Neighborhood Conditions, Psychosocial Factors, and Sleep Problems Among Urban and Rural Older Adults in China

OBJECTIVES

To examine the associations between perceived neighborhood conditions and older Chinese adults' sleep problems, and whether these associations are mediated by psychosocial factors and moderated by urban-rural residence.

METHODS

Data were from the World Health Organization Study on global Ageing and Adult Health. We used OLS, binary, and multinomial logistic regression analyses. Karlson-Holm-Breen decomposition method was used to test mediation effects.

RESULTS

Positively perceived neighborhood social cohesion was associated with fewer insomnia symptoms and decreased odds of poor sleep quality, sleepiness, lethargy, and short sleep duration. Positively perceived neighborhood safety was related to decreased risks of poor sleep quality and sleepiness. Depression and perceived control partially mediated the effects of perceived neighborhood on sleep. Furthermore, the protective effects of neighborhood cohesion against sleep problems were more pronounced among older urban adults than their rural counterparts.

DISCUSSION

Interventions that make neighborhoods safer and more integrated will improve late-life sleep health.

Association between self-perception of the neighborhood environment and sleep problems in older Brazilian adults: findings from ELSI-Brazil

This study aimed to investigate associations between neighborhood perception and sleep problems in older Brazilian adults. A cross-sectional study was conducted with 5,719 community-dwelling older adults (≥ 60 years) from the Brazilian Longitudinal Study of Aging (ELSI-Brazil, 2019-2021). The outcomes were self-reported sleep problems: poor sleep quality, daytime sleepiness, primary insomnia complaints, difficulty staying asleep, and waking up at dawn. The exposure variables were questions about the perception of participants about the physical and social environment of the neighborhood. Logistic regression was used in data analysis. Garbage, rubbish, or tall grass on the streets and the desire to move were associated with higher odds of poor sleep quality. Concern about falling due to damaged sidewalks, concern about having difficulties taking transportation, and concern about having difficulties crossing the street were associated with higher odds of all sleep problems. Sound/noise of buses and cars was associated with higher odds of some sleep problems. Perceiving the neighborhood as a good place to live was associated with lower odds of daytime sleepiness and primary insomnia complaints. Trusting most people in the neighborhood and perceiving that kids and younger people treat adults with respect were associated with lower odds of daytime sleepiness, primary insomnia complaints, and waking up at dawn. Being a good place for kids to play and raise teenagers was associated with lower odds of daytime sleepiness. These results can assist public administrators in creating urban planning policies aimed at improving neighborhood environments as a means of health promotion.

Perceived Neighborhood Characteristics and Sleep in Australian Adults

BACKGROUND

Poor sleep can contribute to poorer health and socioemotional outcomes. Sleep health can be influenced by a range of individual and other socioecological factors. Perceptions of neighborhood physical and social characteristics reflect broader social-level factors that may influence sleep, which have not been well studied in the Australian context. This study examined the association between perceived neighborhood characteristics and sleep in a large sample of Australians.

METHODS

Data were from 9,792 people aged 16 years or older, from Waves 16 and 17 of the nationally representative Household, Income and Labour Dynamics in Australia Survey. Associations between perceived neighborhood characteristics (neighborly interaction and support, environmental noise, physical condition, and insecurity) and self-reported sleep duration, sleep disturbance, and napping were examined using multiple logistic regression models.

RESULTS

"Neighborhood interaction and support" and "neighborhood physical condition" were not significantly associated with any sleep outcomes after adjusting for relevant covariates. However, "environmental noise" and "neighborhood insecurity" remained significantly associated with sleep duration and sleep disturbance. None of the neighborhood characteristics were associated with napping. Furthermore, associations did not significantly vary by gender.

CONCLUSIONS

This study highlights the potential benefit of public health policies to address noise and safety in neighborhoods to improve sleep.

Built Environments and Frailty in Older Adults: The JAGES Longitudinal Study Using Mediation Analysis

OBJECTIVES

The purpose of this study was to investigate the association between subjective built environment and the onset of frailty in older adults living in the community. In addition, we examined whether daily walking time, depressive symptoms, and social support from neighbors and friends are mediating factors.

DESIGN

This was a longitudinal study using prospective cohort data from the 2013 Japan Gerontological Evaluation Study.

SETTING AND PARTICIPANTS

Participants included 38,829 older adults who were not frail recruited from 22 cities and towns.

METHODS

The dependent variable, frailty, was assessed using the Kihon checklist. The explanatory variables were 5 items for the subjective built environment. The mediating variables were walking time of at least 30 minutes per day, a Geriatric Depression Scale (GDS) score of at least 5 points, and social support from neighbors and friends. We performed a causal mediation analysis of mediating effects between each built environment and frailty onset. Furthermore, the proportion of mediation was estimated.

RESULTS

After 3 years of follow-up, frailty emerged in 2232 adults (6.7%) in 2016. Access to parks and sidewalks, access to fresh food stores, houses or facilities where people feel free to drop in, and fascinating views, or buildings reduced the onset of frailty. Mediators significantly associated with the built environment and onset of frailty were access to parks and sidewalks (walking time: 5.9%, GDS: 22.9%, social support: 5.9%), access to fresh food stores (GDS: 31.9%, social support: 4.0%), hills and steps (GDS: 20.6%), houses or facilities where people feel free to drop in (walking time: 4.0%, GDS 28.0%, social support: 10.4%), and fascinating views, or buildings (walking time: 7.8%, GDS: 42.1%, social support: 12.0%).

CONCLUSIONS AND IMPLICATIONS

We found that walking time, depression, and social support were mediating factors in the relationship between built environment and the onset of frailty.

The perceived neighborhood walking environment and self-reported sleep health in a nationally representative sample of the United States

Neighborhood environment can influence sleep health; yet, there is a lack of data on specific environment features in nationally representative samples. We used the 2020 National Health Interview Survey to determine associations between perceived built and social environment factors related to pedestrian access (walking paths, sidewalks), amenities (shops, transit stops, entertainment/services, places to relax), and unsafe walking conditions (traffic, crime) and self-reported sleep duration and disturbances. Places to relax and pedestrian access were associated with better sleep health while unsafe walking conditions were associated with worse sleep health. Access to amenities (shops, transit stops, entertainment venues) had null associations with sleep health.

Neighborhood Built Environment and Sleep Health: A Longitudinal Study in Low-Income and Predominantly African-American Neighborhoods

In the present study, we examined the associations between physical characteristics of neighborhoods and sleep health outcomes and assessed the mediating role of physical activity in these associations. A longitudinal study (the Pittsburgh Hill/Homewood Research on Eating, Shopping, and Health (PHRESH) Zzz Study; n = 1,051) was conducted in 2 low-income, predominately African-American neighborhoods in Pittsburgh, Pennsylvania, with repeated measures of neighborhood characteristics and sleep health outcomes from 2013 to 2018. Built environment measures of walkability, urban design, and neighborhood disorder were captured from systematic field observations. Sleep health outcomes included insufficient sleep, sleep duration, wakefulness after sleep onset, and sleep efficiency measured from 7-day actigraphy data. G-computations based on structural nested mean models were used to examine the total effects of each built environment feature, and causal mediation analyses were used to evaluate direct and indirect effects operating through physical activity. Urban design features were associated with decreased wakefulness after sleep onset (risk difference (RD) = -1.26, 95% confidence interval (CI): -4.31, -0.33). Neighborhood disorder (RD = -0.46, 95% CI: -0.86, -0.07) and crime rate (RD = -0.54, 95% CI: -0.93, -0.08) were negatively associated with sleep efficiency. Neighborhood walkability was not associated with sleep outcomes. We did not find a strong and consistent mediating role of physical activity. Interventions to improve sleep should target modifiable factors, including urban design and neighborhood disorder.

Built environments and frailty in older adults: A three-year longitudinal JAGES study

BACKGROUND

This study investigated the relationship between built environments and the onset of frailty after 3 years.

METHODS

This was a longitudinal study using prospective cohort data from the 2013 Japan Gerontological Evaluation Study on 38,829 older adults nested in 562 comunnities who were not frail. The dependent variable, frailty, was assessed using the Kihon checklist. The explanatory variables were eight items for the built environment at the individual and community levels. To consider each level of built environment simultaneously, multilevel Poisson regression analysis was used to calculate risk ratios and 95% confidence intervals.

RESULTS

After 3 years of follow-up, the onset of frailty was 2740 (7.1%) in 2016. At the individual level, there was an increased risk of developing frailty in negative built environments, such as locations with graffiti or garbage (incidence rate ratio (IRR), 1.15; confidence interval (CI), 1.05-1.25). Positive built environments, such as areas with access to parks and sidewalks (IRR, 0.78; CI, 0.70-0.88), lowered the risk of developing frailty. At the community level, the risk of developing frailty was lower only in areas with locations difficult for walking (hills or steps) (IRR, 0.97; CI, 0.94-0.99).

CONCLUSIONS

At the individual level, frailty onset was associated with all built environments. However, irrespective of their answers, there was a lower risk of developing frailty among older adults living in areas where walking was difficult. It would be desirable to verify whether the risk of developing frailty can be reduced by changing the built environment.

The Effectiveness of a Multi-Sensory Sleep-Promotion Program on Sleep Quality among Hospitalized Older Adults of Thailand: A Quasi-Experimental Study

BACKGROUND/OBJECTIVE

Older adults suffer from sleep disturbances, especially during hospitalization, affecting their health condition, recovery, and in-hospital mortality. Therefore, we aimed to explore the effectiveness of a multi-sensory sleep-promotion program on sleep quality among hospitalized Thai older adults.

METHODS

In a quasi-experimental study, the 52 eligible older adults in a private medical ward were equally assigned into two groups. The experimental group received a sleep quality assessment after the first night of admission, the 60-minute multi-sensory sleep-promotion program for three nights, and an outcome evaluation on the last night after the intervention. In contrast, the control group received routine care for the same period. Sleep quality was measured by the Verran and Snyder-Halpern Sleep Scale (Thai version). In addition, independent and paired samples t-tests compared the sleep quality between and within the two groups.

RESULTS

The older adults in the experimental group had better sleep quality than those who did not (p < .001). Those who participated in the multi-sensory sleep-promotion program markedly improved their sleep quality over five days (p < .001).

CONCLUSION

A multi-sensory sleep-promotion program can promote the sleep quality of older adults. The five alternative methods to promote sleep are effective without the deleterious effects of hypnotics and sedatives often experienced among older adults. Therefore, nurses and other healthcare professionals can implement this program as standard practice. In addition, they may adjust it to fit the acuity level and care dependencies of older adults in other cultures to promote sleep quality.

Neighborhoods and sleep health among adults: A systematic review

OBJECTIVE

Sleep is an important determinant of various health outcomes, and insufficient sleep and sleep disorders are a public health crisis in the United States. The objective of this review is to provide an update on scientific contributions to our understanding of the social/built environmental determinants of sleep health. In particular, this review focuses on the diverse measurements of neighborhood characteristics and sleep outcomes, as well as analytic approaches for quantifying the effect of neighborhood on sleep health.

METHODS

Two major electronic databases were searched and reviewed for relevant articles that examined the associations of social/built environments with sleep health. Inclusion criteria included peer-reviewed empirical studies on neighborhood-level characteristics and sleep health among adult populations.

RESULTS

Systematic searches in MEDLINE/PubMed and SCOPUS identified 52 eligible articles (out of 11,084). Various social/built environmental characteristics of neighborhoods were identified as potential determinants of sleep health, and the majority of studies examined neighborhood social capital, safety, and environmental stressors. However, 88% of included articles employed cross-sectional study designs, limiting causal identification. We found substantial differences in neighborhood measures, variations in sleep health measurements with the majority employing self-reported methods, and inconsistent model specifications. While the majority of articles (48%) utilized perceived neighborhood conditions as the main exposure, more recent studies (23%) employed geographic information systems to measure neighborhood characteristics.

CONCLUSIONS

To establish the causal relationships between social/physical neighborhood characteristics and sleep health, more studies should be conducted with longitudinal, quasi-experimental, and randomized trial designs coupled with objectively measured neighborhood and sleep health parameters.

Associations of insomnia with noise annoyance and neighborhood environments: A nationwide cross-sectional study in Japan

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Data on the association between insomnia and neighborhood noise are lacking.

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Insomnia is associated with noise annoyance from the neighborhood.

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Neighborhood noise should be considered in health and urban policy planning.

Despite the increasing knowledge on the association between neighborhood and health, few studies have investigated sleep disorders in Japan, particularly the impact of neighborhood noise on sleep. Thus, this study aimed to investigate the associations between insomnia symptoms and annoyance because of traffic and neighborhood noise in Japan, which has different neighborhood conditions compared with those of the western societies. Neighborhood built and socioeconomic environments roles were also examined. We used nationwide cross-sectional data collected through a 2015 online survey of Japanese adults aged 20–64 years (n = 4,243). Adjusted prevalence ratios for insomnia according to the exposures were estimated using the multilevel Poisson regression models. The results showed that having insomnia was significantly associated with experiencing neighborhood and traffic-noise annoyance. Neighborhood noise had a stronger and independent association with insomnia. However, the neighborhood environmental variables, including population density, deprivation index, and access to commercial areas, were not associated with insomnia. In conclusion, noise annoyance, particularly that sourced from neighbors, is an important factor in relation to sleep health. Health and urban-planning policymakers should consider neighborhood noise, in addition to traffic noise, as health-related issues in residential neighborhoods.

Resilience Improves the Sleep Quality in Disabled Elders: The Role of Perceived Stress

The current research aims to prove the impact of resilience on sleep quality and to investigate the mediating function of perceived stress in the paths from resilience to sleep quality among disabled Chinese elders. The participants were 196 elders with visual and physical disability who resided in the nursing houses in Shanghai, including 102 males and 94 females whose mean age was 74.5 years old (standard deviation = 6.81). All the elders were measured with the 10-item Connor-Davidson Resilience Scale, Pittsburgh Sleep Quality Index (PSQI), and Perceived Stress Scale. The results showed that all the demographic variables were significantly related to perceived stress and PSQI scores. High levels of resilience could significantly enhance the quality of sleep in disabled Chinese elders. In addition, the two-step mediation models also confirmed the impact of resilience on sleep quality as mediated through perceived stress in this special aged population. Better knowledge on the mechanisms of sleep quality among older adults could benefit the prevention and treatment of some geriatric diseases.

Relationship between neighborhood food environment and diet variety in Japanese rural community-dwelling elderly: a cross-sectional study

Background

Food access is an important aspect of health promotion for the elderly. The aim of this study was to investigate the relationship between distance to the nearest food store and diet variety in rural community-dwelling elderly Japanese.

Methods

This cross-sectional study analyzed data from 1,103 elderly participants surveyed by mail in rural areas of Japan. Diversity of food intake was assessed using the diet variety score (DVS). Street network distance from home to food store was calculated and categorized by quartile using a geographic information system and analyzed in relation to diet using multivariable regression with the primary outcome as low DVS. Sub-analysis of the association with DVS was conducted for each food store category (convenience store, supermarket, and small food store). The association between intake frequency of each food group and distance was also analyzed.

Results

Participants in the fourth quartile of distance to food store had significantly higher prevalence ratio (1.15; 95% CI, 1.01–1.32) for low DVS than those in the first quartile. There was a significant tendency between greater distance to food store and lower DVS (P for trend = 0.033). Supermarkets and convenience stores, in particular, showed significant associations. Greater distance was significantly associated with lower frequency of meat and fruit intake.

Conclusion

There was significant association between distance to nearest food store and diet variety in rural Japanese elderly. These findings suggest the importance of interventions for areas at high risk of low diet variety, such as places far away from food stores.