Kershaw Kiarri N, Robinson Whitney R, Gordon-Larsen Penny, Hicken Margaret T, Goff David C, Carnethon Mercedes R, Kiefe Catarina I, Sidney Stephen, Diez Roux Ana V
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Department of Epidemiology, University of North Carolina Gillings School of Public Health, Chapel Hill.
JAMA Intern Med. 2017 Jul 1;177(7):996-1002. doi: 10.1001/jamainternmed.2017.1226.
Despite cross-sectional evidence linking racial residential segregation to hypertension prevalence among non-Hispanic blacks, it remains unclear how changes in exposure to neighborhood segregation may be associated with changes in blood pressure.
To examine the association of changes in neighborhood-level racial residential segregation with changes in systolic and diastolic blood pressure over a 25-year period.
DESIGN, SETTING, AND PARTICIPANTS: This observational study examined longitudinal data of 2280 black participants of the Coronary Artery Risk Development in Young Adults (CARDIA) study, a prospective investigation of adults aged 18 to 30 years who underwent baseline examinations in field centers in 4 US locations from March 25, 1985, to June 7, 1986, and then were re-examined for the next 25 years. Racial residential segregation was assessed using the Getis-Ord Gi* statistic, a measure of SD between the neighborhood's racial composition (ie, percentage of black residents) and the surrounding area's racial composition. Segregation was categorized as high (Gi* >1.96), medium (Gi* 0-1.96), and low (Gi* <0). Fixed-effects linear regression modeling was used to estimate the associations of within-person change in exposure to segregation and within-person change in blood pressure while tightly controlling for time-invariant confounders. Data analyses were performed between August 4, 2016, and February 9, 2017.
Within-person changes in systolic and diastolic blood pressure across 6 examinations over 25 years.
Of the 2280 participants at baseline, 974 (42.7%) were men and 1306 (57.3%) were women. Of these, 1861 (81.6%) were living in a high-segregation neighborhood; 278 (12.2%), a medium-segregation neighborhood; and 141 (6.2%), a low-segregation neighborhood. Systolic blood pressure increased by a mean of 0.16 (95% CI, 0.06-0.26) mm Hg with each 1-SD increase in segregation score after adjusting for interactions of time with age, sex, and field center. Of the 1861 participants (81.6%) who lived in high-segregation neighborhoods at baseline, reductions in exposure to segregation were associated with reductions in systolic blood pressure. Mean differences in systolic blood pressure were -1.33 (95% CI, -2.26 to -0.40) mm Hg when comparing high-segregation with medium-segregation neighborhoods and -1.19 (95% CI, -2.08 to -0.31) mm Hg when comparing high-segregation with low-segregation neighborhoods after adjustment for time and interactions of time with baseline age, sex, and field center. Changes in segregation were not associated with changes in diastolic blood pressure.
Decreases in exposure to racial residential segregation are associated with reductions in systolic blood pressure. This study adds to the small but growing body of evidence that policies that reduce segregation may have meaningful health benefits.
尽管有横断面证据表明种族居住隔离与非西班牙裔黑人的高血压患病率有关，但尚不清楚邻里隔离暴露的变化与血压变化之间可能存在怎样的关联。
研究邻里层面种族居住隔离的变化与25年间收缩压和舒张压变化之间的关联。
设计、背景和参与者：这项观察性研究分析了青年成人冠状动脉风险发展研究（CARDIA研究）中2280名黑人参与者的纵向数据。该研究是一项针对18至30岁成年人的前瞻性调查，这些成年人于1985年3月25日至1986年6月7日在美国4个地点的现场中心接受了基线检查，并在接下来的25年里接受了复查。使用Getis-Ord Gi统计量评估种族居住隔离情况，该统计量衡量邻里种族构成（即黑人居民百分比）与周边地区种族构成之间的标准差。隔离被分为高（Gi >1.96）、中（Gi* 0 - 1.96）和低（Gi* <0）三类。在严格控制时间不变的混杂因素的同时，使用固定效应线性回归模型来估计隔离暴露的个体内变化与血压的个体内变化之间的关联。数据分析于2016年8月4日至2017年2月9日进行。
25年间6次检查中收缩压和舒张压的个体内变化。
基线时的2280名参与者中，974名（42.7%）为男性，1306名（57.3%）为女性。其中，1861名（81.6%）居住在高隔离社区；278名（12.2%）居住在中等隔离社区；141名（6.2%）居住在低隔离社区。在调整了时间与年龄、性别和现场中心的相互作用后，隔离得分每增加1个标准差，收缩压平均升高0.16（95%CI，0.06 - 0.26）mmHg。在基线时居住在高隔离社区的1861名参与者（81.6%）中，隔离暴露的减少与收缩压的降低有关。在调整时间以及时间与基线年龄、性别和现场中心的相互作用后，高隔离社区与中等隔离社区相比，收缩压的平均差异为 -1.33（95%CI，-2.26至 -0.40）mmHg；高隔离社区与低隔离社区相比，收缩压的平均差异为 -1.19（95%CI，-2.08至 -0.31）mmHg。隔离的变化与舒张压的变化无关。
种族居住隔离暴露的减少与收缩压的降低有关。这项研究进一步补充了虽少但不断增加的证据，表明减少隔离的政策可能对健康有显著益处。
