Sharifi Mona, Sequist Thomas D, Rifas-Shiman Sheryl L, Melly Steven J, Duncan Dustin T, Horan Christine M, Smith Renata L, Marshall Richard, Taveras Elsie M
Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02114, United States.
Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States; Department of Health Care Policy, Harvard Medical School, Boston, MA, United States; Partners HealthCare System, Inc., Boston, MA, United States.
Prev Med. 2016 Oct;91:103-109. doi: 10.1016/j.ypmed.2016.07.009. Epub 2016 Jul 9.
Childhood obesity prevalence remains high and racial/ethnic disparities may be widening. Studies have examined the role of health behavioral differences. Less is known regarding neighborhood and built environment mediators of disparities. The objective of this study was to examine the extent to which racial/ethnic disparities in elevated child body mass index (BMI) are explained by neighborhood socioeconomic status (SES) and built environment.
We collected and analyzed race/ethnicity, BMI, and geocoded address from electronic health records of 44,810 children 4 to 18years-old seen at 14 Massachusetts pediatric practices in 2011-2012. Main outcomes were BMI z-score and BMI z-score change over time. We used multivariable linear regression to examine associations between race/ethnicity and BMI z-score outcomes, sequentially adjusting for neighborhood SES and the food and physical activity environment.
Among 44,810 children, 13.3% were black, 5.7% Hispanic, and 65.2% white. Compared to white children, BMI z-scores were higher among black (0.43units [95% CI: 0.40-0.45]) and Hispanic (0.38 [0.34-0.42]) children; black (0.06 [0.04-0.08]), but not Hispanic, children also had greater increases in BMI z-score over time. Adjusting for neighborhood SES substantially attenuated BMI z-score differences among black (0.30 [0.27-0.34]) and Hispanic children (0.28 [0.23-0.32]), while adjustment for food and physical activity environments attenuated the differences but to a lesser extent than neighborhood SES.
Neighborhood SES and the built environment may be important drivers of childhood obesity disparities. To accelerate progress in reducing obesity disparities, interventions must be tailored to the neighborhood contexts in which families live.
儿童肥胖患病率仍然很高，种族/族裔差异可能正在扩大。已有研究探讨了健康行为差异所起的作用。对于邻里和建成环境在差异中的调节作用，人们了解较少。本研究的目的是探讨邻里社会经济地位（SES）和建成环境在多大程度上解释了儿童体重指数（BMI）升高方面的种族/族裔差异。
我们从2011 - 2012年在马萨诸塞州14家儿科诊所就诊的44810名4至18岁儿童的电子健康记录中收集并分析了种族/族裔、BMI以及地理编码地址。主要结局指标是BMI z评分以及BMI z评分随时间的变化。我们使用多变量线性回归来研究种族/族裔与BMI z评分结局之间的关联，并依次对邻里SES以及食物和身体活动环境进行调整。
在44810名儿童中，13.3%为黑人，5.7%为西班牙裔，65.2%为白人。与白人儿童相比，黑人（0.43个单位[95%置信区间：0.40 - 0.45]）和西班牙裔（0.38[0.34 - 0.42]）儿童的BMI z评分更高；黑人儿童（0.06[0.04 - 0.08]），而非西班牙裔儿童，其BMI z评分随时间的增加也更大。对邻里SES进行调整后，黑人（0.30[0.27 - 0.34]）和西班牙裔儿童（0.28[0.23 - 0.32]）的BMI z评分差异大幅减小，而对食物和身体活动环境进行调整后，差异虽有减小，但程度小于邻里SES。
邻里SES和建成环境可能是儿童肥胖差异的重要驱动因素。为加快减少肥胖差异方面的进展，干预措施必须根据家庭居住的邻里环境进行调整。
