Morenoff Jeffrey D, House James S, Hansen Ben B, Williams David R, Kaplan George A, Hunte Haslyn E
University of Michigan, 33361 ISR, PO Box 1248, Ann Arbor, MI 48106-1248, USA.
Soc Sci Med. 2007 Nov;65(9):1853-66. doi: 10.1016/j.socscimed.2007.05.038. Epub 2007 Jul 20.
The spatial segregation of the US population by socioeconomic position and especially race/ethnicity suggests that the social contexts or "neighborhoods" in which people live may substantially contribute to social disparities in hypertension. The Chicago Community Adult Health Study did face-to-face interviews, including direct measurement of blood pressure, with a representative probability sample of adults in Chicago. These data were used to estimate socioeconomic and racial-ethnic disparities in the prevalence, awareness, treatment, and control of hypertension, and to analyze how these disparities are related to the areas in which people live. Hypertension was significantly negatively associated with neighborhood affluence/gentrification, and adjustments for context eliminated the highly significant disparity between blacks/African-Americans and whites, and reduced the significant educational disparity by 10-15% to borderline statistical significance. Awareness of hypertension was significantly higher in more disadvantaged neighborhoods and in places with higher concentrations of blacks (and lower concentrations of Hispanics and immigrants). Adjustment for context completely eliminated blacks' greater awareness, but slightly accentuated the lesser awareness of Hispanics and the greater levels of awareness among the less educated. There was no consistent evidence of either social disparities in or contextual associations with treatment of hypertension, given awareness. Among those on medication, blacks were only 40-50% as likely as whites to have their hypertension controlled, but context played little or no role in either the level of or disparities in control of hypertension. In sum, residential contexts potentially play a large role in accounting for racial/ethnic and, to a lesser degree, socioeconomic disparities in hypertension prevalence and, in a different way, awareness, but not in treatment or control of diagnosed hypertension.
美国人口按社会经济地位,尤其是种族/族裔的空间隔离表明,人们生活的社会环境或“社区”可能在很大程度上导致了高血压方面的社会差异。芝加哥社区成人健康研究对芝加哥具有代表性概率样本的成年人进行了面对面访谈,包括直接测量血压。这些数据被用于估计高血压患病率、知晓率、治疗率和控制率方面的社会经济及种族/族裔差异,并分析这些差异与人们居住地区的关系。高血压与社区富裕程度/高档化显著负相关,对环境因素进行调整后,消除了黑人/非裔美国人和白人之间的高度显著差异,并将显著的教育差异降低了10 - 15%,使其达到临界统计学显著性。在处境更不利的社区以及黑人聚居程度较高(西班牙裔和移民聚居程度较低)的地方,高血压知晓率显著更高。对环境因素进行调整后,完全消除了黑人较高的知晓率,但略微加剧了西班牙裔较低的知晓率以及受教育程度较低者中较高的知晓率。在已知晓高血压的情况下,没有一致的证据表明高血压治疗存在社会差异或与环境因素有关联。在接受药物治疗的人群中,黑人高血压得到控制的可能性仅为白人的40 - 50%,但环境因素在高血压控制水平或控制差异方面几乎没有起到作用。总之,居住环境在解释高血压患病率方面的种族/族裔差异以及在较小程度上的社会经济差异方面可能发挥很大作用,在知晓率方面以不同方式发挥作用,但在已确诊高血压的治疗或控制方面则不然。