University of Chicago, Chicago, IL 60637, USA.
N Engl J Med. 2011 Oct 20;365(16):1509-19. doi: 10.1056/NEJMsa1103216.
The question of whether neighborhood environment contributes directly to the development of obesity and diabetes remains unresolved. The study reported on here uses data from a social experiment to assess the association of randomly assigned variation in neighborhood conditions with obesity and diabetes.
From 1994 through 1998, the Department of Housing and Urban Development (HUD) randomly assigned 4498 women with children living in public housing in high-poverty urban census tracts (in which ≥40% of residents had incomes below the federal poverty threshold) to one of three groups: 1788 were assigned to receive housing vouchers, which were redeemable only if they moved to a low-poverty census tract (where <10% of residents were poor), and counseling on moving; 1312 were assigned to receive unrestricted, traditional vouchers, with no special counseling on moving; and 1398 were assigned to a control group that was offered neither of these opportunities. From 2008 through 2010, as part of a long-term follow-up survey, we measured data indicating health outcomes, including height, weight, and level of glycated hemoglobin (HbA(1c)).
As part of our long-term survey, we obtained data on body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) for 84.2% of participants and data on glycated hemoglobin level for 71.3% of participants. Response rates were similar across randomized groups. The prevalences of a BMI of 35 or more, a BMI of 40 or more, and a glycated hemoglobin level of 6.5% or more were lower in the group receiving the low-poverty vouchers than in the control group, with an absolute difference of 4.61 percentage points (95% confidence interval [CI], -8.54 to -0.69), 3.38 percentage points (95% CI, -6.39 to -0.36), and 4.31 percentage points (95% CI, -7.82 to -0.80), respectively. The differences between the group receiving traditional vouchers and the control group were not significant.
The opportunity to move from a neighborhood with a high level of poverty to one with a lower level of poverty was associated with modest but potentially important reductions in the prevalence of extreme obesity and diabetes. The mechanisms underlying these associations remain unclear but warrant further investigation, given their potential to guide the design of community-level interventions intended to improve health. (Funded by HUD and others.).
邻里环境是否直接导致肥胖和糖尿病的发展，这个问题仍未得到解决。本研究利用一项社会实验的数据来评估随机分配的邻里环境条件变化与肥胖和糖尿病之间的关联。
1994 年至 1998 年期间，住房和城市发展部（HUD）将居住在高贫困城市普查区（其中≥40%的居民收入低于联邦贫困线）的 4498 名有孩子的妇女随机分配到三组中的一组：1788 名被分配到可以获得住房券，但只有搬到贫困率较低的普查区（<10%的居民贫困）并接受搬迁咨询的一组；1312 名被分配到可以获得不受限制的传统住房券但不接受搬迁咨询的一组；1398 名被分配到既没有获得这些机会的对照组。作为长期随访调查的一部分，2008 年至 2010 年，我们测量了健康结果的数据，包括身高、体重和糖化血红蛋白（HbA1c）水平。
作为我们长期调查的一部分，我们获得了 84.2%参与者的体重指数（BMI，体重以千克为单位除以身高以米为单位的平方）数据和 71.3%参与者的糖化血红蛋白水平数据。随机分组的应答率相似。与对照组相比，获得贫困率较低住房券的组中 BMI 为 35 或以上、BMI 为 40 或以上和糖化血红蛋白水平为 6.5%或以上的比例较低，绝对差值分别为 4.61 个百分点（95%置信区间[CI]，-8.54 至-0.69）、3.38 个百分点（95% CI，-6.39 至-0.36）和 4.31 个百分点（95% CI，-7.82 至-0.80）。获得传统住房券的组与对照组之间的差异不显著。
从贫困程度较高的社区搬迁到贫困程度较低的社区的机会与肥胖和糖尿病的患病率适度但可能重要的降低有关。这些关联的潜在机制尚不清楚，但鉴于它们有可能指导旨在改善健康的社区层面干预措施的设计，因此值得进一步研究。（由 HUD 和其他机构资助）。
