社区层面的种族/族裔居住隔离与心血管疾病事件：动脉粥样硬化多民族研究
Neighborhood-level racial/ethnic residential segregation and incident cardiovascular disease: the multi-ethnic study of atherosclerosis.
作者信息
Kershaw Kiarri N, Osypuk Theresa L, Do D Phuong, De Chavez Peter J, Diez Roux Ana V
机构信息
From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.N.K., P.J.D.C.); Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN (T.L.O.); Departments of Public Health Policy & Administration, and Epidemiology, University of Wisconsin-Milwaukee, Milwaukee, WI (D.P.D.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.R.).
出版信息
Circulation. 2015 Jan 13;131(2):141-8. doi: 10.1161/CIRCULATIONAHA.114.011345. Epub 2014 Dec 1.
BACKGROUND
Previous research suggests that neighborhood-level racial/ethnic residential segregation is linked to health, but it has not been studied prospectively in relation to cardiovascular disease (CVD).
METHODS AND RESULTS
Participants were 1595 non-Hispanic black, 2345 non-Hispanic white, and 1289 Hispanic adults from the Multi-Ethnic Study of Atherosclerosis free of CVD at baseline (aged 45-84 years). Own-group racial/ethnic residential segregation was assessed by using the Gi* statistic, a measure of how the neighborhood racial/ethnic composition deviates from surrounding counties' racial/ethnic composition. Multivariable Cox proportional hazards modeling was used to estimate hazard ratios for incident CVD (first definite angina, probable angina followed by revascularization, myocardial infarction, resuscitated cardiac arrest, coronary heart disease death, stroke, or stroke death) over 10.2 median years of follow-up. Among blacks, each standard deviation increase in black segregation was associated with a 12% higher hazard of developing CVD after adjusting for demographics (95% confidence interval, 1.02-1.22). This association persisted after adjustment for neighborhood-level characteristics, individual socioeconomic position, and CVD risk factors (hazard ratio, 1.12; 95% confidence interval, 1.02-1.23). For whites, higher white segregation was associated with lower CVD risk after adjusting for demographics (hazard ratio, 0.88; 95% confidence interval, 0.81-0.96), but not after further adjustment for neighborhood characteristics. Segregation was not associated with CVD risk among Hispanics. Similar results were obtained after adjusting for time-varying segregation and covariates.
CONCLUSIONS
The association of residential segregation with cardiovascular risk varies according to race/ethnicity. Further work is needed to better characterize the individual- and neighborhood-level pathways linking segregation to CVD risk.
背景
先前的研究表明，社区层面的种族/民族居住隔离与健康有关，但尚未对其与心血管疾病（CVD）的关系进行前瞻性研究。
方法与结果
参与者为来自动脉粥样硬化多民族研究的1595名非西班牙裔黑人、2345名非西班牙裔白人以及1289名西班牙裔成年人，他们在基线时（年龄45 - 84岁）无心血管疾病。使用Gi*统计量评估本种族/民族居住隔离情况，该统计量用于衡量社区种族/民族构成与周边县种族/民族构成的差异程度。在中位随访10.2年期间，采用多变量Cox比例风险模型估计发生心血管疾病（首次明确心绞痛、可能心绞痛后行血运重建、心肌梗死、复苏的心脏骤停、冠心病死亡、中风或中风死亡）的风险比。在黑人中，经人口统计学因素调整后，黑人隔离程度每增加一个标准差，患心血管疾病的风险就会增加12%（95%置信区间为1.02 - 1.22）。在调整社区层面特征、个人社会经济地位和心血管疾病风险因素后，这种关联依然存在（风险比为1.12；95%置信区间为1.02 - 1.23）。对于白人，经人口统计学因素调整后，白人隔离程度越高，心血管疾病风险越低（风险比为0.88；95%置信区间为0.81 - 0.96），但在进一步调整社区特征后则无此关联。西班牙裔中，隔离与心血管疾病风险无关。在调整随时间变化的隔离和协变量后，得到了类似的结果。
结论
居住隔离与心血管疾病风险的关联因种族/民族而异。需要进一步开展工作，以更好地描述将隔离与心血管疾病风险联系起来的个体和社区层面的途径。
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