Dawson Aprill Z, Walker Rebekah J, Gregory Chris, Egede Leonard E
Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave., Milwaukee, WI 53226, USA.
Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA.
Int J Cardiol Hypertens. 2019 May 25;2:100011. doi: 10.1016/j.ijchy.2019.100011. eCollection 2019 Aug.
This study examined the relationship between immigrant specific social determinants of health (SDoH) and blood pressure control. Data on 181 adult immigrants from the Midwestern United States was analyzed. SDoH variables were categorized based on antecedents, predisposing, enabling, and need factors. Systolic blood pressure (SBP) was the primary outcome. Pearson's correlations for the association between SBP and SDoH variables were assessed. Then three different regression approaches were used to assess the relationship of SDoH variables with SBP: sequential model, stepwise regression with backward selection, and all possible subsets regression. About 66% were female and mean age was 45.4 years. Age (r = 0.34, p < 0.001), disability (r = 0.20, p = 0.0001), comorbidities (r = 0.30, p < 0.001), and chronic pain (r = 0.12, p = 0.02) were positively correlated with SBP, and number of hours worked per week (r = -0.11, p = 0.028) was negatively correlated with SBP. The final sequential model found life-course socioeconomic status (SES) (β = 1.40, p = 0.039), age (β = 0.39, p < 0.001), and male sex (β = 13.62, p < 0.001) to be positively associated with SBP. Stepwise regression found that life-course SES (β = 1.70, p = 0.026), age (β = 0.36, p < 0.001), male sex (β = 13.38, p < 0.001), and homelessness as a child (β = 13.14, p = 0.034) were positively associated SBP. All possible subsets regression found that age (β = 0.44, p < 0.001), male sex (β = 14.50, p < 0.001), and homelessness as a child (β = 14.08, p = 0.027) were positively associated with SBP. This is the first study to use a theory-based model that incorporates social determinants of health and immigrant specific factors to examine the relationship between SDoH and blood pressure control and identifies potential targets for interventions to control BP in immigrants.
本研究探讨了移民特有的健康社会决定因素（SDoH）与血压控制之间的关系。分析了来自美国中西部的181名成年移民的数据。SDoH变量根据先行因素、易患因素、促成因素和需求因素进行分类。收缩压（SBP）是主要结果。评估了SBP与SDoH变量之间关联的Pearson相关性。然后使用三种不同的回归方法来评估SDoH变量与SBP的关系：序列模型、向后选择的逐步回归和所有可能子集回归。约66%为女性，平均年龄为45.4岁。年龄（r = 0.34，p < 0.001）、残疾（r = 0.20，p = 0.0001）、合并症（r = 0.30，p < 0.001）和慢性疼痛（r = 0.12，p = 0.02）与SBP呈正相关，每周工作小时数（r = -0.11，p = 0.028）与SBP呈负相关。最终的序列模型发现生命历程社会经济地位（SES）（β = 1.40，p = 0.039）、年龄（β = 0.39，p < 0.001）和男性性别（β = 13.62，p < 0.001）与SBP呈正相关。逐步回归发现生命历程SES（β = 1.70，p = 0.026）、年龄（β = 0.36，p < 0.001）、男性性别（β = 13.38，p < 0.001）和儿童时期无家可归（β = 13.14，p = 0.034）与SBP呈正相关。所有可能子集回归发现年龄（β = 0.44，p < 0.001）、男性性别（β = 14.50，p < 0.001）和儿童时期无家可归（β = 14.08，p = 0.027）与SBP呈正相关。这是第一项使用基于理论的模型来研究SDoH与血压控制之间关系的研究，该模型纳入了健康的社会决定因素和移民特有的因素，并确定了控制移民血压的潜在干预目标。
