D'Agostino-McGowan Lucy, Gennarelli Renee L, Lyons Sarah A, Goodman Melody S
Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
Int J Environ Res Public Health. 2013 Dec 27;11(1):418-28. doi: 10.3390/ijerph110100418.
Data on the national and state levels is often used to inform policy decisions and strategies designed to reduce racial disparities in obesity. Obesity-related health outcomes are realized on the individual level, and policies based on state and national-level data may be inappropriate due to the variations in health outcomes within and between states. To examine county-level variation of obesity within states, we use a small-area analysis technique to fill the void for county-level obesity data by race. Five years of Behavioral Risk Factor Surveillance System data are used to estimate the prevalence of obesity by county, both overall and race-stratified. A modified weighting system is used based on demographics at the county level using 2010 census data. We fit a multilevel reweighted regression model to obtain county-level prevalence estimates by race. We compare the distribution of prevalence estimates of non-Hispanic Blacks to non-Hispanic Whites. For 25 of the 26 states included in our analysis there is a statistically significant difference between within-state county-level average obesity prevalence rates for non-Hispanic Whites and non-Hispanic Blacks. This study provides information needed to target disparities interventions and resources to the local areas with greatest need; it also identifies the necessity of doing so.
国家和州层面的数据常被用于为旨在减少肥胖方面种族差异的政策决策和策略提供信息。与肥胖相关的健康结果体现在个体层面，而基于州和国家层面数据的政策可能并不合适，因为州内以及不同州之间的健康结果存在差异。为了研究州内各县肥胖情况的差异，我们使用一种小区域分析技术来填补按种族划分的县级肥胖数据空白。利用行为风险因素监测系统五年的数据来估计各县总体及按种族分层的肥胖患病率。基于2010年人口普查数据，使用县级人口统计数据构建了一个修正加权系统。我们拟合了一个多层次重新加权回归模型以获得按种族划分的县级患病率估计值。我们比较了非西班牙裔黑人与非西班牙裔白人患病率估计值的分布情况。在我们分析的26个州中的25个州，非西班牙裔白人和非西班牙裔黑人在州内县级平均肥胖患病率之间存在统计学上的显著差异。本研究提供了将差异干预措施和资源针对最需要的地区所需的信息；它还确定了这样做的必要性。
