Sheets Lincoln R, Henderson Kelley Laura E, Scheitler-Ring Kristen, Petroski Gregory F, Barnett Yan, Barnett Chris, Kind Amy J H, Parker Jerry C
School of Medicine, University of Missouri, United States.
Center for Applied Research and Environmental Systems, University of Missouri, United States.
Prev Med Rep. 2020 Feb 19;18:101067. doi: 10.1016/j.pmedr.2020.101067. eCollection 2020 Jun.
Neighborhood context impacts health. Using an index of geospatial disadvantage measures to predict neighborhood socioeconomic disparities would support area-based allocation of preventative resources, as well as the use of location as a clinical risk factor in care of individual patients. This study tested the association of the Area Deprivation Index (ADI), a neighborhood-based index of socioeconomic contextual disadvantage, with elderly obesity risk. We sampled 5066 Medicare beneficiaries at the University of Missouri between September 1, 2013 and September 1, 2014. We excluded patients with unknown street addresses, excluded body mass index (BMI) lower than 18 or higher than 62 as probable errors, and excluded patients with missing BMI data. We used a plot of simple proportions to examine the association between ADI and prevalence of obesity, defined as BMI of 30 and over. We found that obesity was significantly less prevalent in the least-disadvantaged ADI decile (decile 1) than in all other deciles (p < 0.05) except decile 7. Obesity prevalence within the other deciles (2-6 and 8-10) was not significantly distinguishable except that decile 2 was significantly lower than decile 4. Patients with missing BMI data were more likely to reside in the most disadvantaged areas. There was a positive association between neighborhood disadvantage and obesity in this Midwestern United States Medicare population. The association of missing BMI information with neighborhood disadvantage may reflect unmeasured gaps in care delivery to the most disadvantaged patients. These preliminary results support the continued study of neighborhood socioeconomic measures to identify health disparities in populations.
邻里环境影响健康。使用地理空间劣势指标来预测邻里社会经济差异，将有助于基于地区分配预防资源，以及在个体患者护理中将地理位置作为临床风险因素。本研究测试了基于邻里的社会经济背景劣势指标——地区剥夺指数（ADI）与老年人肥胖风险之间的关联。我们在2013年9月1日至2014年9月1日期间，对密苏里大学的5066名医疗保险受益人进行了抽样。我们排除了街道地址不明的患者，将体重指数（BMI）低于18或高于62的情况作为可能的误差排除，并排除了BMI数据缺失的患者。我们使用简单比例图来检验ADI与肥胖患病率（定义为BMI≥30）之间的关联。我们发现，在最不劣势的ADI十分位数（十分位数1）中，肥胖患病率显著低于除十分位数7之外的所有其他十分位数（p<0.05）。除十分位数2显著低于十分位数4外，其他十分位数（2 - 6和8 - 10）内的肥胖患病率没有显著差异。BMI数据缺失的患者更有可能居住在最劣势的地区。在美国中西部医疗保险人群中，邻里劣势与肥胖之间存在正相关。BMI信息缺失与邻里劣势之间的关联可能反映了在为最劣势患者提供护理方面存在未测量的差距。这些初步结果支持继续研究邻里社会经济指标，以确定人群中的健康差异。
