Cubbin C, Hadden W C, Winkleby M A
Stanford Center for Research in Disease Prevention, Stanford University School of Medicine, Palo Alto, California, USA.
Ethn Dis. 2001 Fall;11(4):687-700.
This paper investigates whether neighborhood material deprivation is associated with cardiovascular disease (CVD) risk factors (physical inactivity, diabetes, smoking, body mass index, blood pressure, cholesterol) independent of individual socioeconomic status (SES) in Black, Mexican-American, and White women and men aged 25-64 using data from the Third National Health and Nutrition Examination Survey (1988-1994, N = 9,961). The data were linked to 1990 Census tract characteristics (unemployment, car ownership, rented housing, crowded housing), which were used to construct a neighborhood-level material deprivation index. Results are stratified by gender and race/ethnicity. Multiple logistic and linear regression models were specified using SUDAAN to account for the clustered design. In general, residence in a deprived neighborhood increased the probability of having an adverse CVD risk profile, independent of an individual's SES. For example, after adjusting for SES, Black women living in deprived neighborhoods were at increased risk of being diabetic, being a smoker, and having a higher body mass index and blood pressure compared to Black women living in less deprived neighborhoods (P values <.05). Stronger associations were found between neighborhood deprivation and CVD risk factors in Blacks than in Mexican Americans despite living in similarly deprived neighborhoods. Neighborhood deprivation may influence CVD risk factors through a variety of mechanisms including the availability of healthy environments, municipal services, and political/cultural characteristics. Policies and interventions that address the socioeconomic context in which people live might reduce inequalities in CVD risk factors.
本文利用第三次全国健康和营养检查调查（1988 - 1994年，N = 9961）的数据，研究了25 - 64岁的黑人、墨西哥裔美国人和白人女性及男性中，邻里物质匮乏是否独立于个体社会经济地位（SES）与心血管疾病（CVD）风险因素（身体活动不足、糖尿病、吸烟、体重指数、血压、胆固醇）相关。这些数据与1990年人口普查区特征（失业、汽车拥有情况、租房、住房拥挤程度）相关联，用于构建邻里层面的物质匮乏指数。结果按性别和种族/族裔进行分层。使用SUDAAN指定了多个逻辑回归和线性回归模型，以考虑聚类设计。总体而言，居住在匮乏邻里会增加出现不良CVD风险状况的概率，且独立于个体的SES。例如，在调整SES后，与居住在匮乏程度较低邻里的黑人女性相比，居住在匮乏邻里的黑人女性患糖尿病、吸烟、体重指数和血压较高的风险增加（P值<.05）。尽管居住在类似匮乏程度的邻里，但黑人中邻里匮乏与CVD风险因素之间的关联比墨西哥裔美国人更强。邻里匮乏可能通过多种机制影响CVD风险因素，包括健康环境的可及性、市政服务以及政治/文化特征。解决人们生活的社会经济背景的政策和干预措施可能会减少CVD风险因素方面的不平等。
