Epidemiology. 2018 Mar;29(2):207-214. doi: 10.1097/EDE.0000000000000792.
Despite 50 years since the passage of the Fair Housing Act of 1968, the majority of black Americans continue to live in highly segregated communities. Differing exposure to obesogenic environments in segregated neighborhoods may contribute to racial disparities in obesity prevalence.
We used prospective data from the Coronary Artery Risk Development in Young Adults (CARDIA) study to examine associations between levels of neighborhood-level racial residential segregation and incident obesity in black men and women. Obesity, determined by measured anthropometry, and residential segregation, measured using the local Gi*statistic, were recorded at baseline and follow-up at years 7, 10, 15, 20, and 25. We used marginal structural survival models to account for time-dependent confounding and for loss to follow-up.
Black women living in highly segregated neighborhoods at the prior exam were 30% more likely to become obese during the follow-up period as compared with women living in neighborhoods with low levels of segregation after adjustment for sociodemographic and cardiovascular risk covariates (hazard ratio = 1.3 [95% confidence interval = 1.0, 1.7]). Cumulatively high exposure to segregation averaged across time points was associated with 50% higher hazard of obesity (hazard ratio = 1.5 [95% confidence interval = 1.0, 2.3]) among women. We observed few differences in obesity incidence among men by segregation levels.
Fewer health-promoting resources, stressful neighborhood context, and social norms that are less stigmatizing of obesity may contribute to these findings, but more research on specific pathways leading from segregation to obesity is needed to understand differing patterns between men and women.
尽管自 1968 年《公平住房法案》通过以来已经过去了 50 年，但大多数美国黑人仍然生活在高度隔离的社区中。在隔离的社区中，对肥胖环境的不同暴露可能导致肥胖患病率的种族差异。
我们使用来自年轻人冠状动脉风险发展（CARDIA）研究的前瞻性数据，研究了社区层面的种族居住隔离水平与黑人群体中男性和女性肥胖的发生之间的关联。肥胖是通过测量人体测量学来确定的，居住隔离是通过局部 Gi*统计来衡量的，它们在基线和随访时（第 7、10、15、20 和 25 年）进行记录。我们使用边缘结构生存模型来解释时间依赖性混杂因素和随访损失。
与生活在低隔离程度社区的女性相比，在前一次检查中生活在高度隔离社区的黑人女性在随访期间肥胖的可能性增加了 30%（调整社会人口学和心血管风险协变量后的危险比=1.3[95%置信区间为 1.0，1.7]）。平均而言，随着时间的推移，累积高度的隔离暴露与女性肥胖的风险增加 50%（危险比=1.5[95%置信区间为 1.0，2.3]）相关。我们观察到，男性的肥胖发生率因隔离程度的不同而没有差异。
促进健康的资源较少、紧张的邻里环境以及对肥胖的歧视程度较低的社会规范可能导致了这些发现，但需要更多关于导致隔离和肥胖的具体途径的研究，以了解男性和女性之间不同的模式。
