Winkleby M A, Cubbin C
Stanford Center for Research in Disease Prevention, Stanford University School of Medicine, Palo Alto, CA 94304-1825, USA.
J Epidemiol Community Health. 2003 Jun;57(6):444-52. doi: 10.1136/jech.57.6.444.
s: This study examines the influence of individual and neighbourhood socioeconomic status (SES) on mortality among black, Mexican-American, and white women and men in the US. The authors had three study objectives. Firstly, they examined mortality rates by both individual level SES (measured by income, education, and occupational/employment status) and neighbourhood level SES (index of neighbourhood income/wealth, educational attainment, occupational status, and employment status). Secondly, they examined whether neighbourhood SES was associated with mortality after controlling for individual SES. Thirdly, they calculated the population attributable risk to estimate the reduction in mortality rates if all women and men lived in the highest SES neighbourhoods.
National Health Interview Survey (1987-1994), linked with 1990 census tract (neighbourhood proxy) and mortality data through 1997.
SETTING/PARTICIPANTS: Nationally representative sample of 59 935 black, 19 201 Mexican-American, and 344 432 white men and women (six gender and racial/ethnic groups), aged 25-64 at interview.
Mortality rates for all six gender and racial/ethnic groups were two to four times higher for those with the lowest incomes (lowest quartile) who lived in the lowest SES neighbourhoods (lowest tertile) compared with those with the highest incomes who lived in the highest SES neighbourhoods. For the six groups, the age adjusted mortality risk associated with living in the lowest SES neighbourhoods ranged from 1.43 to 1.61. The mortality risk decreased but remained significant (p values <.05) after adjusting for each of the three individual measures of SES, with the exception of Mexican-American women. Furthermore, the mortality risk associated with living in the lowest SES neighbourhoods remained significant after simultaneously adjusting for all three individual measures of SES for white men (p<0.001) and white women (p<0.05). Deaths would hypothetically be reduced by about 20% for each subgroup if everyone had the same death rates as those living in the highest SES neighbourhoods (highest tertile).
Living in a low SES neighbourhood confers additional mortality risk beyond individual SES.
本研究考察了美国黑人、墨西哥裔美国人和白人男性及女性中个人及邻里社会经济地位（SES）对死亡率的影响。作者有三个研究目标。其一，他们通过个人层面的社会经济地位（以收入、教育程度和职业/就业状况衡量）和邻里层面的社会经济地位（邻里收入/财富、教育程度、职业地位和就业状况指数）来考察死亡率。其二，他们在控制了个人社会经济地位之后，考察邻里社会经济地位是否与死亡率相关。其三，他们计算了人群归因风险，以估计如果所有男性和女性都生活在社会经济地位最高的邻里中，死亡率会降低多少。
全国健康访谈调查（1987 - 1994年），与1990年人口普查区（邻里代表）以及截至1997年的死亡率数据相链接。
背景/参与者：全国代表性样本，包括59935名黑人、19201名墨西哥裔美国人以及344432名白人男性和女性（六个性别及种族/族裔群体），访谈时年龄在25 - 64岁。
与生活在社会经济地位最高邻里（最高三分位数）的高收入者相比，生活在社会经济地位最低邻里（最低三分位数）的低收入者（最低四分位数）中，所有六个性别及种族/族裔群体的死亡率高出两到四倍。对于这六个群体，与生活在社会经济地位最低邻里相关的年龄调整后死亡风险在1.43至1.61之间。除墨西哥裔美国女性外，在对三项个人社会经济地位指标中的每一项进行调整后，死亡风险降低但仍具有显著性（p值 <.05）。此外，对于白人男性（p < 0.001）和白人女性（p < 0.05），在同时对所有三项个人社会经济地位指标进行调整后，与生活在社会经济地位最低邻里相关的死亡风险仍具有显著性。假设每个亚组中每个人的死亡率都与生活在社会经济地位最高邻里（最高三分位数）的人相同，那么每个亚组的死亡人数将减少约20%。
生活在社会经济地位低的邻里会带来超出个人社会经济地位的额外死亡风险。
