Walkable urban zip codes and specific chronic diseases are associated with Sarcopenia

Background: Sarcopenia is an aging-related disease characterized by muscle mass loss and wasting, and is among the most significant causes of frailty among the elderly. Despite it being a detrimental condition, it only recently, as of October 1, 2016, received the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code, M62. 84, thus being recognized as a distinct disease. This study evaluated patient characteristics for sarcopenia using hospital data from the first six years since the adoption of the ICD-10-CM code, and its associations with residential walkability and comorbidities. Methods: The Mass General Brigham Research Patient Data Registry was used to query for cases with ICD-10 code, M62.84 between October 1, 2016 and October 1, 2022. For each case, a control was identified matched on sex, age and race. The inclusion criteria were patients at the Massachusetts General Hospital or Brigham and Women’s Hospital, with Massachusetts residential zip codes, excluding employees. The main association of interest was whether Walk Score was associated with sarcopenia. Additional factors evaluated were marital status and aging-related chronic disease comorbidities. Univariable and multivariable logistic regression analyses were performed to compute odds ratios. Results: The final analysis included 685 subjects (343 sarcopenia cases and 342 controls). The mean ± standard deviation of age of sarcopenia diagnosis record was 77.53 ± 11.47. Univariable logistic regression analysis found highly walkable neighborhoods of ‘very walkable’ (OR [95% CI]: 1.734 [1.197-2.522], p=0.0037) and ‘walker’s paradise’ (OR [95% CI]: 2.958 [1.664-5.455], p=0.0003) to be associated with sarcopenia. In the multivariable logistic regression model adjusted for sex, race, ethnicity, median household income and marital status, ‘very walkable’ (OR [95% CI]: 1.648 [1.069-2.551], p=0.0242) and ‘walker’s paradise’ (OR [95% CI]: 2.624 [1.404-5.078], p=0.0031) remained to be associated. The multivariable logistic regression model additionally including chronic diseases found that ‘walker’s paradise’ (OR [95% CI]: 2.898 [1.497-5.788], p=0.0020) to be associated. Diabetes (OR [95% CI]: 1.655 [1.122-2.453], p=0.0115), dementia, (OR [95% CI]: 5.154 [3.291-8.270], p=2.71x10 ^-12 ) and chronic obstructive pulmonary disease (OR [95% CI]: 2.497 [1.558-4.066], p=0.0002) were associated with sarcopenia, while cancer and cardiovascular diseases with stroke were not. Conclusions: Increased residential walkability is associated with increased odds of sarcopenia. Diabetes, dementia and COPD are significant comorbidities, while cancer and stroke were not found to be significantly associated. Future longitudinal studies evaluating lifetime residential walkability and comorbidities in relation to sarcopenia would aid in further elucidating how those factors can impact sarcopenia outcome.