Feng Xiaoqi, Wilson Andrew
Early Start Research Institute, University of Wollongong, Wollongong, NSW, Australia School of Health and Society, University of Wollongong, Wollongong, NSW, Australia Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
BMJ Open. 2015 Sep 16;5(9):e007052. doi: 10.1136/bmjopen-2014-007052.
A recent analysis of the Australian National Health Survey (2011-2012) reported that the patterning of overweight and obesity among men, unlike for women, was not associated with neighbourhood socioeconomic disadvantage. The purpose of this study was to examine whether this gender difference in potential neighbourhood 'effects' on adult weight status can be observed in analyses of a different source of data.
DESIGN, SETTING AND PARTICIPANTS: A cross-sectional sample of 14 693 people aged 18 years or older was selected from the 2012 wave of the 'Household, Income and Labour Dynamics in Australia' (HILDA). Three person-level outcomes were considered: (1) body mass index (BMI); (2) a binary indicator of 'normal weight' versus 'overweight or obese'; and (3) 'normal weight or overweight' versus 'obese'. Area-level socioeconomic circumstances were measured using quintiles of the Socio Economic Index For Areas (SEIFA). Multilevel linear and logistic regression models were used to examine associations while accounting for clustering within households and neighbourhoods, adjusting for person-level socioeconomic confounders.
Neighbourhood-level factors accounted for 4.9% of the overall variation in BMI, whereas 20.1% was attributable to household-level factors. Compared with their peers living in deprived neighbourhoods, mean BMI was 0.7 kg/m(2) lower among men and 2.2 kg/m(2) lower among women living in affluent areas, with a clear trend across categories. Similarly, the percentage of overweight and obese, and obesity specifically, was lower in affluent areas for both men and women. These results were robust to adjustment for confounders.
Unlike findings from the national health survey, but in line with evidence from other high-income countries, this study finds an inverse patterning of BMI by neighbourhood disadvantage for men, and especially among women. The potential mediators which underpin this gender difference in BMI within disadvantaged neighbourhoods warrant further investigation.
最近一项对澳大利亚国民健康调查(2011 - 2012年)的分析报告称,与女性不同,男性超重和肥胖的分布模式与邻里社会经济劣势无关。本研究的目的是检验在对另一数据源的分析中,是否能观察到这种邻里环境对成年人健康状况潜在“影响”的性别差异。
设计、背景与参与者:从2012年“澳大利亚家庭、收入与劳动力动态”(HILDA)调查中选取了14693名18岁及以上的横断面样本。考虑了三个个体层面的结果:(1)体重指数(BMI);(2)“正常体重”与“超重或肥胖”的二元指标;(3)“正常体重或超重”与“肥胖”。使用地区社会经济指数(SEIFA)五分位数来衡量地区层面的社会经济状况。采用多水平线性和逻辑回归模型来检验关联,同时考虑家庭和邻里内部的聚类情况,并对个体层面的社会经济混杂因素进行调整。
邻里层面的因素占BMI总体变异的4.9%,而20.1%可归因于家庭层面的因素。与生活在贫困社区的同龄人相比,生活在富裕地区的男性平均BMI低0.7kg/m²,女性低2.2kg/m²,且各类别间有明显趋势。同样,富裕地区男性和女性超重和肥胖的比例,尤其是肥胖的比例较低。这些结果在对混杂因素进行调整后依然稳健。
与国家健康调查的结果不同,但与其他高收入国家的证据一致,本研究发现邻里劣势与男性BMI呈反向分布模式,女性中尤其如此。在弱势社区中导致这种BMI性别差异的潜在中介因素值得进一步研究。