Taylor Wendell C, Durand Casey P, Knell Gregory
Department of Health Promotion and Behavioral Sciences, Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas.
Health Equity. 2019 Dec 13;3(1):612-618. doi: 10.1089/heq.2019.0064. eCollection 2019.
The purpose of this study was to compare state rankings of body mass index (BMI) among three different indices of income disparities (i.e., low-, middle-, and high-income thresholds) and BMI. One measure of disparities was based on national standards and the other measure was based on state-specific data. Data were from the 2016 Behavioral Risk Factor Surveillance System and analyzed in 2018. To assess differences between the two indices, Spearman Rank Order Correlation coefficient with a Bonferroni adjustment and kappa statistic were used. Spearman rank-order correlation coefficient with a Bonferroni adjustment found that the two indices had a very weak monotonic relationship (ρ=0.11, =0.46). The kappa value [κ (df=48)=0.02, -value=0.43] revealed the indices were not concordant. The rankings of states based on national and state-specific disparity indices were distinctly different. Our study highlights the importance of choosing disparity indices. To analyze state similarities and differences, findings and interpretations are different when using a national standard applied to all states versus state-specific data as the frame of reference for the disparity index. Future research is needed to confirm the generalizability of our findings. In addition to income, our approach can be used with other sociodemographic variables such as age, race/ethnicity, sex, and education. The overall goal is to present a comprehensive and nuanced perspective of disparities contributing to the overweight/obesity epidemic.
本研究的目的是比较三种不同收入差距指数（即低收入、中等收入和高收入阈值）与体重指数（BMI）之间的州排名情况。一种差距衡量标准基于国家标准，另一种基于各州特定数据。数据来自2016年行为风险因素监测系统，并于2018年进行分析。为评估这两种指数之间的差异，使用了经邦费罗尼校正的斯皮尔曼等级相关系数和kappa统计量。经邦费罗尼校正的斯皮尔曼等级相关系数表明，这两种指数具有非常弱的单调关系（ρ=0.11，P=0.46）。kappa值[κ（自由度=48）=0.02，P值=0.43]显示这两种指数不一致。基于国家和各州特定差距指数的州排名明显不同。我们的研究强调了选择差距指数的重要性。为分析各州的异同，以适用于所有州的国家标准与以各州特定数据作为差距指数的参照标准时，结果和解释是不同的。需要未来的研究来证实我们研究结果的普遍性。除收入外，我们的方法还可用于其他社会人口统计学变量，如年龄、种族/族裔、性别和教育程度。总体目标是呈现一个全面且细致入微的视角，以了解导致超重/肥胖流行的差距情况。
