Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 North Lake Shore Drive, Suite 1400, Chicago, IL 60611, USA.
Am J Epidemiol. 2011 Sep 1;174(5):537-45. doi: 10.1093/aje/kwr116. Epub 2011 Jun 22.
Few studies have examined geographic variation in hypertension disparities, but studies of other health outcomes indicate that racial residential segregation may help to explain these variations. The authors used data from 8,071 black and white participants in the National Health and Nutrition Examination Survey (1999-2006) who were aged 25 years or older to investigate whether black-white hypertension disparities varied by level of metropolitan-level racial residential segregation and whether this was explained by race differences in neighborhood poverty. Racial segregation was measured by using the black isolation index. After adjustment for demographics and individual-level socioeconomic position, blacks had 2.74 times higher odds of hypertension than whites (95% confidence interval (CI): 2.32, 3.25). However, race differences were significantly smaller in low- than in high-segregation areas (P(interaction) = 0.006). Race differences in neighborhood poverty did not explain this heterogeneity, but poverty further modified race disparities: Race differences were largest in segregated, low-poverty areas (odds ratio = 4.14, 95% CI: 3.18, 5.38) and smallest in nonsegregated, high-poverty areas (odds ratio = 1.24, 95% CI: 0.77, 2.01). These findings suggest that racial disparities in hypertension are not invariant and are modified by contextual levels of racial segregation and neighborhood poverty, highlighting the role of environmental factors in the genesis of disparities.
很少有研究探讨高血压差异的地域差异，但其他健康结果的研究表明，种族居住隔离可能有助于解释这些差异。作者使用了 1999 年至 2006 年期间参加全国健康和营养检查调查的 8071 名黑人和白人参与者的数据，这些参与者年龄在 25 岁或以上，以调查大都市种族居住隔离程度的高低是否会导致黑人和白人高血压差异的变化，以及这种差异是否可以用邻里贫困的种族差异来解释。种族隔离程度是通过使用黑人隔离指数来衡量的。在调整了人口统计学和个体社会经济地位后，黑人患高血压的几率是白人的 2.74 倍（95%置信区间：2.32，3.25）。然而，在低隔离程度地区，种族差异明显小于高隔离程度地区（P（交互）=0.006）。邻里贫困程度的种族差异并不能解释这种异质性，但贫困进一步改变了种族差异：在隔离程度高、贫困程度低的地区，种族差异最大（比值比=4.14，95%置信区间：3.18，5.38），而在非隔离程度高、贫困程度高的地区，种族差异最小（比值比=1.24，95%置信区间：0.77，2.01）。这些发现表明，高血压的种族差异不是不变的，而是受到种族隔离和邻里贫困程度的环境因素的影响，突出了环境因素在差异形成中的作用。
