Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Ann Epidemiol. 2011 Apr;21(4):245-52. doi: 10.1016/j.annepidem.2010.11.015.
To determine if the spatial pattern of gonorrhea observed for North Carolina was influenced by neighborhood-level sociocultural determinants of health, including race/ethnicity.
A generalized linear mixed model with spatially correlated random effects was fit to measure the influence of socio-cultural factors on the spatial pattern of gonorrhea reported to the North Carolina State Health Department (January 1, 2005 to March 31, 2008).
Neighborhood gonorrhea rates increased as the percent single mothers increased (25th to 75th neighborhood percentile Relative Rate 1.18, 95% CI 1.12, 1.25), and decreased as socioeconomic status increased (Relative Rate 0.89, 95% CI 0.84, 0.95). Increasing numbers of men in neighborhoods with more women than men did not change the gonorrhea rate, but was associated with decreased rates in neighborhoods with more men than women. Living in the mountains was protective for all race/ethnicities. Rurality was associated with decreased rates for Blacks and increased rates for Native Americans outside the mountains.
Neighborhood-level sociocultural factors, primarily those indicative of neighborhood deprivation, explained a significant proportion of the spatial pattern of gonorrhea in both urban and rural communities. Race/ethnicity was an important proxy for social and cultural factors not captured by measures of socioeconomic status.
确定北卡罗来纳州淋病的空间模式是否受到包括种族/民族在内的邻里健康社会文化决定因素的影响。
采用具有空间相关随机效应的广义线性混合模型，衡量社会文化因素对北卡罗来纳州卫生部门报告的淋病空间模式的影响（2005 年 1 月 1 日至 2008 年 3 月 31 日）。
邻里淋病发病率随着单身母亲比例的增加而增加（第 25 至 75 个邻里百分位数相对比率为 1.18，95%置信区间为 1.12，1.25），随着社会经济地位的提高而降低（相对比率为 0.89，95%置信区间为 0.84，0.95）。邻里中男性人数的增加并不会改变淋病的发病率，但与女性多于男性的邻里的发病率降低有关。生活在山区对所有种族/民族都有保护作用。农村地区与黑人的发病率降低和山区以外的美洲原住民的发病率升高有关。
邻里层面的社会文化因素，主要是那些表明邻里贫困的因素，解释了城乡社区淋病空间模式的很大一部分。种族/民族是无法通过社会经济地位衡量的社会和文化因素的重要指标。
