Lilly Christa L, Umer Amna, Cottrell Lesley, Pyles Lee, Neal William
West Virginia University, Morgantown, West Virginia, USA.
Rural Remote Health. 2017 Jan-Mar;17(1):4200. doi: 10.22605/rrh4200. Epub 2017 Mar 20.
The prevalence of childhood cardiovascular disease (CVD) risk factors often increases in more rural geographic regions in the USA. However, research on the topic often has conflicting results. Researchers note differences in definitions of rurality and other factors that would lead to differences in inference, including appropriate use of statistical clustering analysis, representative data, and inclusion of individual-level covariates. The present study's objective was to examine CVD risk factors during childhood by geographic distribution in the US Appalachian region as a first step towards understanding the health disparities in this area.
Rurality and CVD risk factors (including blood pressure, body-mass index (BMI), and cholesterol) were examined in a large, representative sample of fifth-grade students (73 014) from an Appalachian state in the USA. A six-category Rural-Urban Continuum Codes classification system was used to define rurality regions. Mixed modeling analysis was used to appropriately cluster individuals within 725 unique zip codes in each of these six regions, and allowed for including several individual-level socioeconomic factors as covariates.
Rural areas had better outcomes for certain CVD risk factors (lowest low-density lipoprotein cholesterol (LDL-C), and blood pressure (BP) and highest high-density lipoprotein cholesterol (HDL-C)) whereas mid-sized metro and town areas presented with the worst CVD risk factors (highest BMI% above ideal, mean diastolic BP, LDL-C, total cholesterol, triglyceride levels and lowest HDL-C) outcomes in children and adolescence in this Appalachian state.
Counter to the study hypothesis, mid-sized metro areas presented with the worst CVD risk factors outcomes in children and adolescence in the Appalachian state. This data contradicts previous literature suggesting a straightforward link between rurality and cardiovascular risk factors. Future research should include a longitudinal design and explore some of the mechanisms between cardiovascular risk factors and rurality.
在美国，儿童心血管疾病（CVD）危险因素的患病率在更为偏远的农村地区往往呈上升趋势。然而，关于这一主题的研究结果常常相互矛盾。研究人员指出，农村地区的定义以及其他因素存在差异，这些差异会导致推断结果不同，包括统计聚类分析的恰当使用、代表性数据以及个体层面协变量的纳入。本研究的目的是通过美国阿巴拉契亚地区的地理分布来研究儿童期的心血管疾病危险因素，以此作为了解该地区健康差异的第一步。
对来自美国阿巴拉契亚某州的大量具有代表性的五年级学生样本（73014名）进行农村地区划分及心血管疾病危险因素（包括血压、体重指数（BMI）和胆固醇）的调查。采用六类城乡连续编码分类系统来定义农村地区。使用混合模型分析对这六个地区中725个独特邮政编码区域内的个体进行恰当聚类，并将若干个体层面的社会经济因素作为协变量纳入分析。
农村地区在某些心血管疾病危险因素方面有较好的结果（最低的低密度脂蛋白胆固醇（LDL-C）、血压（BP）以及最高的高密度脂蛋白胆固醇（HDL-C）），而中型城市和城镇地区在该阿巴拉契亚州儿童和青少年中呈现出最差的心血管疾病危险因素结果（高于理想值的最高BMI%、平均舒张压、LDL-C、总胆固醇、甘油三酯水平以及最低的HDL-C）。
与研究假设相反，中型城市地区在该阿巴拉契亚州儿童和青少年中呈现出最差的心血管疾病危险因素结果。这些数据与之前表明农村地区与心血管危险因素之间存在直接联系的文献相矛盾。未来的研究应采用纵向设计，并探索心血管危险因素与农村地区之间的一些机制。
