Inagami Sanae, Cohen Deborah A, Finch Brian K
VA Greater Los Angeles Health Care System, Los Angeles, CA, USA.
Soc Sci Med. 2007 Oct;65(8):1779-91. doi: 10.1016/j.socscimed.2007.05.051. Epub 2007 Jul 5.
In prior research, neighborhood effects have often been weak or inconsistent in predicting specific causes of mortality and morbidity. To determine whether residential neighborhood effects are suppressed by exposure to other environments, we examined the effect on adult self-rated health of non-residential environments that figure in individuals' daily routines. We linked the 2000 US Census data with the Los Angeles Family and Neighborhood Study (L.A.FANS) database, which consists of 3323 adults sampled from neighborhoods in LA County. Characteristics of census tracts where respondents lived, worked, shopped, sought medical care, worshipped and spent "other" time were obtained from the 2000 US Census. Weighted multilevel linear and clustered generalized ordered logistic regressions were used to estimate associations between self-rated health and non-residential neighborhood exposures after adjustment for individual-level factors and exposure to residential neighborhoods. We found that residence in disadvantaged neighborhoods was associated with worse self-rated health. In a dose-response fashion, the greater the exposure to less disadvantaged non-residential neighborhoods in the course of routine activities, the greater the magnitude in improved self-rated health. Models including non-residential neighborhood exposure increase the magnitude and significance of the association between residential neighborhoods and health. In conclusion, individuals' exposure to non-residential neighborhoods confounds and suppresses the association of residential neighborhoods with health and could explain why previous studies may not have found robust associations between residential neighborhood predictors and health.
在先前的研究中，邻里效应在预测死亡率和发病率的具体成因方面往往较弱或并不一致。为了确定居住邻里效应是否会因接触其他环境而受到抑制，我们研究了个体日常活动中所涉及的非居住环境对成年人自评健康状况的影响。我们将2000年美国人口普查数据与洛杉矶家庭与邻里研究（L.A.FANS）数据库相链接，该数据库包含从洛杉矶县各邻里抽取的3323名成年人。通过2000年美国人口普查获取了受访者居住、工作、购物、就医、做礼拜以及度过“其他”时间的普查区特征。在对个体层面因素和居住邻里接触情况进行调整之后，使用加权多级线性回归和聚类广义有序逻辑回归来估计自评健康状况与非居住邻里接触之间的关联。我们发现，居住在弱势邻里与较差的自评健康状况相关。以剂量反应方式来看，在日常活动过程中接触到的弱势程度较低的非居住邻里越多，自评健康状况改善的幅度就越大。纳入非居住邻里接触情况的模型增强了居住邻里与健康之间关联的强度和显著性。总之，个体对非居住邻里的接触混淆并抑制了居住邻里与健康之间的关联，这可以解释为什么先前的研究可能未发现居住邻里预测因素与健康之间存在强有力的关联。
