Beresford Shirley Aa, Bowen Deborah J, Littman Alyson J, Albano Denise L, Chan Kc Gary, Langer Shelby L, Barrington Wendy E, Patrick Donald L
Department of Epidemiology, University of Washington, Seattle, USA.
Cancer Prevention Program, Fred Hutch, Seattle, USA.
Int J Womens Health Wellness. 2019;5(1). doi: 10.23937/2474-1353/1510090. Epub 2019 Feb 28.
Obesity rates differ between Hispanic and White (non-Hispanic) women in the United States, with higher rates among Hispanic women. Socioeconomic processes contribute to this disparity both at the individual and the environmental level. Understanding these complex relationships requires multilevel analyses within cohorts of women that have a shared environment. In population-based samples of Hispanic and White (non-Hispanic) women from the same neighborhoods, we evaluated within each ethnic group a) The association of individual-level socioeconomic status (SES) with body mass index (BMI); and b) The additional contribution of neighborhood-level measures of SES.
Using population-based multi-stage sampling methods, we oversampled low SES and Hispanic block groups. During household screening, we identified women aged 30 to 50 years. Among White women, we specifically oversampled women with low educational levels. 515 Hispanic and 503 White women completed baseline. Height and weight were measured. Baseline surveys, in Spanish and English, included four measures of SES. Three measures of area-level SES were examined. Analysis of log BMI on each SES measure used linear mixed models, incorporating design effects.
Among White women, low education, social status, and neighborhood SES were associated with higher BMI (p < 0.001, p < 0.0001, and p < 0.05, respectively), independent of other SES measures. Although the highest grouped category of education, income and subjective social status within the Hispanic cohort had the lowest mean estimated BMI, the point estimates across categories were not monotonic, and had wide confidence intervals. As a result, in contrast to the findings among White women, no statistically significant associations were found between BMI and measures of SES among Hispanic women.
Neighborhood and individual measures of SES operate differently in Hispanic compared with White women. We had assumed the measures we included to be most salient and operate similarly for both groups of women. Rather the salient factors for Hispanic women have yet to be identified. Improved understanding may ultimately inform the design of culturally-relevant multilevel obesity prevention strategies.
在美国，西班牙裔和白人（非西班牙裔）女性的肥胖率存在差异，西班牙裔女性的肥胖率更高。社会经济因素在个体和环境层面都导致了这种差异。要理解这些复杂的关系，需要在具有共同环境的女性队列中进行多层次分析。在来自相同社区的西班牙裔和白人（非西班牙裔）女性的基于人群的样本中，我们在每个种族群体中评估了：a）个体层面社会经济地位（SES）与体重指数（BMI）之间的关联；b）邻里层面SES指标的额外影响。
我们采用基于人群的多阶段抽样方法，对低SES和西班牙裔街区组进行了过度抽样。在家庭筛查期间，我们确定了年龄在30至50岁之间的女性。在白人女性中，我们专门对低教育水平的女性进行了过度抽样。515名西班牙裔女性和503名白人女性完成了基线调查。测量了身高和体重。用西班牙语和英语进行的基线调查包括四项SES指标。研究了三项区域层面的SES指标。对每个SES指标的对数BMI进行分析时使用了线性混合模型，并纳入了设计效应。
在白人女性中，低教育水平、社会地位和邻里SES与较高的BMI相关（分别为p < 0.001、p < 0.0001和p < 0.05），独立于其他SES指标。尽管西班牙裔队列中教育、收入和主观社会地位的最高分组类别平均估计BMI最低，但各分类之间的点估计并非单调，且置信区间较宽。因此，与白人女性的研究结果相反，在西班牙裔女性中未发现BMI与SES指标之间存在统计学上的显著关联。
与白人女性相比，邻里和个体层面的SES指标在西班牙裔女性中的作用方式不同。我们曾假设我们纳入的指标对两组女性最为显著且作用相似。然而，西班牙裔女性的显著因素尚未确定。更好的理解最终可能为设计与文化相关的多层次肥胖预防策略提供信息。
