邻里环境与累积生物风险因素的社会差异。
Neighborhood context and social disparities in cumulative biological risk factors.
机构信息
Sociology Department, Box 90088, Duke University, Durham, NC 27708, USA.
出版信息
Psychosom Med. 2011 Sep;73(7):572-9. doi: 10.1097/PSY.0b013e318227b062. Epub 2011 Aug 23.
OBJECTIVE
This study examines the role of neighborhood context in the accumulation of biological risk factors and racial/ethnic and socioeconomic disparities.
METHODS
Data came from face-to-face interviews and blood sample collection on a probability sample of adults (n = 549) in the 2002 Chicago Community Adult Health Study. Following the approach of prior studies, we constructed an index of cumulative biological risk (CBR) by counting how many of eight biomarkers exceeded clinically defined criteria for "high risk": systolic and diastolic blood pressure, resting heart rate, hemoglobin A(1c), C-reactive protein, waist size, and total and high-density lipoprotein cholesterol. Data are presented as incidence rate ratios (IRRs) based on generalized linear models with a Poisson link function and population-average estimates with robust standard errors.
RESULTS
Non-Hispanic blacks (n = 200), Hispanics (n = 149), and people with low (n = 134) and moderate (n = 275) level of education had significantly higher numbers of biological risks than their respective reference groups (IRR = 1.48, 1.59, 1.62, and 1.48, respectively, with p < .01). Black-white (p < .001) and Hispanic-white (p < .003) disparities in CBR remained significant after adjusting for individual-level socioeconomic position and behavioral factors, whereas individual-level controls substantially diminished the low/high (p < .069) and moderate/high (p < .042) educational differences. Estimating "within-neighborhood" disparities to adjust for neighborhood context fully explained the black-white gap in CBR (p < .542) and reduced the Hispanic-white gap to borderline significance (p < .053). Neighborhood affluence predicted lower levels of CBR (IRR = 0.82, p < .027), but neighborhood disadvantage was not significantly associated with CBR (IRR = 1.00, p < .948).
CONCLUSIONS
Neighborhood environments seem to play a pivotal role in the accumulation of biological risk and disparities therein.
目的
本研究探讨了邻里环境在生物风险因素积累以及种族/民族和社会经济差异方面的作用。
方法
数据来自于 2002 年芝加哥社区成人健康研究中对概率抽样成年人（n=549）进行的面对面访谈和血液样本采集。我们采用先前研究的方法，通过计算 8 种生物标志物中有多少种超过临床定义的“高风险”标准来构建累积生物风险（CBR）指数：收缩压和舒张压、静息心率、血红蛋白 A1c、C 反应蛋白、腰围以及总胆固醇和高密度脂蛋白胆固醇。使用具有泊松链接函数的广义线性模型和具有稳健标准误差的总体估计值呈现数据，结果表示为发病率比（IRR）。
结果
非西班牙裔黑人（n=200）、西班牙裔（n=149）以及受教育程度低（n=134）和中等（n=275）的人群的生物风险数量明显高于各自的参照组（IRR 分别为 1.48、1.59、1.62 和 1.48，p<.01）。在调整个体社会经济地位和行为因素后，黑人和白人（p<.001）以及西班牙裔和白人（p<.003）之间的 CBR 差异仍然显著，而个体水平的对照则大大降低了低/高（p<.069）和中/高（p<.042）受教育程度差异。估计“邻里内”差异以充分调整邻里环境，这完全解释了 CBR 中的黑人和白人差距（p<.542），并将西班牙裔和白人差距缩小到边缘显著（p<.053）。邻里富裕程度预测 CBR 水平较低（IRR=0.82，p<.027），但邻里劣势与 CBR 无显著关联（IRR=1.00，p<.948）。
结论
邻里环境似乎在生物风险的积累及其差异方面起着关键作用。
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