Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY 10029, United States.
Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY 10029, United States.
Prev Med. 2018 Jul;112:126-129. doi: 10.1016/j.ypmed.2018.04.014. Epub 2018 Apr 12.
Reducing chronic disease is a major health challenge. Risk factors for chronic diseases are often studied at the individual level, even though interventions and policies may be implemented at the city level. We use an ecologic study design with city-level data, to simultaneously assess the relative impact of unhealthy behaviors and preventive care measures on multiple chronic disease health outcomes. We analyze a newly available, large national dataset called the 500 Cities Project. We examine the associations between city-level prevalence of unhealthy behaviors, clinical preventive service use, and all chronic disease health outcomes in 500 of the largest U.S. cities for year 2014. After adjusting for age and demographic characteristics, using MANOVA we found that the top three risk factors for all health outcomes are smoking (Pillai's trace = 0.95, approx. F = 688.7, p-value < 0.0001), lack of physical activity (Pillai's trace = 0.91, approx. F = 380.0, p-value < 0.0001) and binge drinking (Pillai's trace = 0.91, approx. F = 348.8, p-value < 0.0001), which are statistically significant after adjusting for multiple comparisons. Higher prevalence of an annual dental checkup, a preventive service use measure, is correlated with lower prevalence of several chronic diseases such as diabetes (correlation coefficient r = -0.88), poor physical health (r = -0.91), stroke (r = -0.85), cardiovascular disease (r = -0.83) and poor mental health (r = -0.82). Identifying important chronic disease risk factors at the city-level may provide more actionable information for policymakers to improve urban health.
减少慢性病是一项重大的健康挑战。慢性病的风险因素通常在个体层面进行研究，尽管干预措施和政策可能在城市层面实施。我们使用城市层面数据的生态研究设计，同时评估不健康行为和预防保健措施对多种慢性病健康结果的相对影响。我们分析了一个新的、可用的大型国家数据集，称为 500 个城市项目。我们研究了 2014 年美国 500 个最大城市的城市级不健康行为流行率、临床预防服务使用与所有慢性病健康结果之间的关联。在调整年龄和人口特征后，我们使用 MANOVA 发现，所有健康结果的前三个风险因素是吸烟（Pillai 的迹 = 0.95，近似 F = 688.7，p 值 < 0.0001）、缺乏身体活动（Pillai 的迹 = 0.91，近似 F = 380.0，p 值 < 0.0001）和狂饮（Pillai 的迹 = 0.91，近似 F = 348.8，p 值 < 0.0001），这些因素在进行多次比较调整后具有统计学意义。每年进行一次牙科检查的更高流行率，作为一种预防服务使用措施，与糖尿病（相关系数 r = -0.88）、身体不健康（r = -0.91）、中风（r = -0.85）、心血管疾病（r = -0.83）和心理健康不佳（r = -0.82）等几种慢性病的较低流行率相关。在城市层面确定重要的慢性病风险因素可能为政策制定者提供更具操作性的信息，以改善城市健康。
