Cubbin Catherine, Sundquist Kristina, Ahlén Helena, Johansson Sven-Erik, Winkleby Marilyn A, Sundquist Jan
Center on Social Disparities in Health, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California 94143-0900, USA.
Scand J Public Health. 2006;34(3):228-37. doi: 10.1080/14034940500327935.
To determine whether neighborhood-level deprivation is independently associated with cardiovascular disease (CVD) health behaviors/risk factors in the Swedish population.
Pooled cross-sectional data, Swedish Annual Level of Living Survey (1996-2000) linked with indicators of neighborhood-level (i.e. Small Area Market Statistics areas) deprivation (1997), to examine the association between neighborhood-level deprivation and individual-level smoking, physical inactivity, obesity, diabetes, and hypertension among women and men, aged 25-64 (n = 18,081). Data were analyzed with a series of logistic regression models that adjusted for individual-level age, gender, marital status, immigration status, urbanization, and a comprehensive measure of socioeconomic status (SES). Interactions were tested to determine whether neighborhood effects varied by SES or length of neighborhood exposure.
Living in a neighborhood with low deprivation was protective (i.e. lower odds) for smoking, while living in a neighborhood with high deprivation was harmful (i.e. higher odds) for smoking, physical inactivity, and obesity (compared with living in a neighborhood with moderate deprivation). These associations were significant after adjustment for individual-level characteristics. There was no evidence that the neighborhood deprivation associations varied by individual-level SES or length of neighborhood exposure.
Neighborhood-level deprivation exerted important protective and harmful associations with health behaviors/risk factors related to CVD. The significance to public health is substantial because of the number of persons at risk as well as the serious health consequences of CVD. These results suggest that interventions focusing on changing contextual aspects of neighborhoods, in addition to changing individual behaviors, may have a greater impact on CVD than a sole focus on individuals.
确定瑞典人群中邻里层面的贫困是否与心血管疾病（CVD）健康行为/风险因素独立相关。
汇总横断面数据，将瑞典年度生活水平调查（1996 - 2000年）与邻里层面（即小区域市场统计区域）贫困指标（1997年）相联系，以研究25 - 64岁男女（n = 18,081）中邻里层面贫困与个人层面吸烟、缺乏身体活动、肥胖、糖尿病和高血压之间的关联。使用一系列逻辑回归模型对数据进行分析，这些模型对个人层面的年龄、性别、婚姻状况、移民身份、城市化以及社会经济地位（SES）的综合指标进行了调整。测试了交互作用以确定邻里效应是否因SES或邻里暴露时长而异。
生活在贫困程度低的邻里环境对吸烟有保护作用（即较低的几率），而生活在贫困程度高的邻里环境对吸烟、缺乏身体活动和肥胖有有害影响（即较高的几率）（与生活在贫困程度中等的邻里环境相比）。在对个人层面特征进行调整后，这些关联具有统计学意义。没有证据表明邻里贫困关联因个人层面的SES或邻里暴露时长而异。
邻里层面的贫困与CVD相关的健康行为/风险因素存在重要的保护和有害关联。鉴于高危人群数量以及CVD的严重健康后果，对公共卫生的意义重大。这些结果表明，除了改变个人行为外，专注于改变邻里环境背景因素的干预措施可能比单纯关注个人对CVD产生更大影响。
