Wing Jeffrey J, August Ella, Adar Sara D, Dannenberg Andrew L, Hajat Anjum, Sánchez Brisa N, Stein James H, Tattersall Matthew C, Diez Roux Ana V
From Department of Public Health, Grand Valley State University, Grand Rapids, MI (J.J.W.); Departments of Epidemiology (E.A., S.D.A.) and Biostatistics (B.S.), University of Michigan School of Public Health, Ann Arbor; Departments of Environmental and Occupational Health Sciences (A.L.D.) and Epidemiology (A.H.), University of Washington School of Public Health, Seattle; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (J.H.S., M.C.T.); and Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University School of Public Health, Philadelphia, PA (A.V.D.R.).
Circulation. 2016 Aug 16;134(7):504-13. doi: 10.1161/CIRCULATIONAHA.115.020534.
Although some evidence shows that neighborhood deprivation is associated with greater subclinical atherosclerosis, prior studies have not identified what aspects of deprived neighborhoods were driving the association.
We investigated whether social and physical neighborhood characteristics are related to the progression of subclinical atherosclerosis in 5950 adult participants of the MESA (Multi-Ethnic Study of Atherosclerosis) during a 12-year follow-up period. We assessed subclinical disease using coronary artery calcium (CAC). Neighborhood features examined included density of recreational facilities, density of healthy food stores, and survey-based measures of availability of healthy foods, walking environment, and social environment. We used econometric fixed-effects models to investigate how change in a given neighborhood exposure is related to simultaneous change in subclinical atherosclerosis.
Increases in density of neighborhood healthy food stores were associated with decreases in CAC (mean changes in CAC Agatston units per 1-SD increase in neighborhood exposures, -19.99; 95% confidence interval, -35.21 to -4.78) after adjustment for time-varying demographic confounders and computed tomography scanner type. This association remained similar in magnitude after additional adjustment for time-varying behavioral risk factors and depression. The addition of time-varying biomedical factors attenuated associations with CAC slightly (mean changes in CAC per 1-SD increase in neighborhood exposures, -17.60; 95% confidence interval, -32.71 to -2.49). Changes across time in other neighborhood measures were not significantly associated with within-person change in CAC.
Results from this longitudinal study provide suggestive evidence that greater access to neighborhood healthy food resources may slow the development of coronary atherosclerosis in middle-aged and older adults.
尽管有证据表明社区贫困与更严重的亚临床动脉粥样硬化有关，但先前的研究尚未确定贫困社区的哪些方面导致了这种关联。
我们调查了在12年的随访期内，5950名动脉粥样硬化多族裔研究（MESA）的成年参与者中，社区的社会和物理特征是否与亚临床动脉粥样硬化的进展有关。我们使用冠状动脉钙化（CAC）评估亚临床疾病。所考察的社区特征包括娱乐设施密度、健康食品店密度以及基于调查的健康食品可及性、步行环境和社会环境的测量指标。我们使用计量经济学固定效应模型来研究给定社区暴露的变化与亚临床动脉粥样硬化的同步变化之间的关系。
在调整了随时间变化的人口统计学混杂因素和计算机断层扫描仪类型后，社区健康食品店密度的增加与CAC的降低相关（社区暴露每增加1个标准差，CAC阿加斯顿单位的平均变化为-19.99；95%置信区间为-35.21至-4.78）。在进一步调整了随时间变化的行为风险因素和抑郁后，这种关联的强度仍然相似。加入随时间变化的生物医学因素后，与CAC的关联略有减弱（社区暴露每增加1个标准差，CAC的平均变化为-17.60；95%置信区间为-32.71至-2.49）。其他社区测量指标随时间的变化与个体内CAC的变化无显著关联。
这项纵向研究的结果提供了提示性证据，表明社区健康食品资源的更多可及性可能会减缓中老年人群冠状动脉粥样硬化的发展。
