Shaw Kate M, Theis Kristina A, Self-Brown Shannon, Roblin Douglas W, Barker Lawrence
Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS E28, Chamblee, GA 30329-4027. Email:
Centers for Disease Control and Prevention, Atlanta, Georgia.
Prev Chronic Dis. 2016 Sep 1;13:E119. doi: 10.5888/pcd13.160088.
Racial/ethnic disparities have been studied extensively. However, the combined influence of geographic location and economic status on specific health outcomes is less well studied. This study's objective was to examine 1) the disparity in chronic disease prevalence in the United States by county economic status and metropolitan classification and 2) the social gradient by economic status. The association of hypertension, arthritis, and poor health with county economic status was also explored.
We used 2013 Behavioral Risk Factor Surveillance System data. County economic status was categorized by using data on unemployment, poverty, and per capita market income. While controlling for sociodemographics and other covariates, we used multivariable logistic regression to evaluate the relationship between economic status and hypertension, arthritis, and self-rated health.
Prevalence of hypertension, arthritis, and poor health in the poorest counties was 9%, 13%, and 15% higher, respectively, than in the most affluent counties. After we controlled for covariates, poor counties still had a higher prevalence of the studied conditions.
We found that residents of poor counties had a higher prevalence of poor health outcomes than affluent counties, even after we controlled for known risk factors. Further, the prevalence of poor health outcomes decreased as county economics improved. Findings suggest that poor counties would benefit from targeted public health interventions, better access to health care services, and improved food and built environments.
种族/民族差异已得到广泛研究。然而，地理位置和经济状况对特定健康结果的综合影响研究较少。本研究的目的是：1）按县经济状况和大都市分类研究美国慢性病患病率的差异；2）按经济状况研究社会梯度。还探讨了高血压、关节炎及健康状况不佳与县经济状况之间的关联。
我们使用了2013年行为危险因素监测系统的数据。通过失业、贫困和人均市场收入数据对县经济状况进行分类。在控制社会人口统计学和其他协变量的同时，我们使用多变量逻辑回归来评估经济状况与高血压、关节炎及自评健康之间的关系。
最贫困县的高血压、关节炎和健康状况不佳的患病率分别比最富裕县高9%、13%和15%。在我们控制协变量后，贫困县所研究疾病的患病率仍然较高。
我们发现，即使在控制了已知危险因素之后，贫困县居民健康状况不佳的患病率仍高于富裕县。此外，随着县经济状况的改善，健康状况不佳的患病率有所下降。研究结果表明，贫困县将从有针对性的公共卫生干预措施、更好地获得医疗服务以及改善食品和建筑环境中受益。
