Rodrigues Daiana Elias, César Cibele Comini, Xavier César Coelho, Caiaffa Waleska Teixeira, Proietti Fernando Augusto
Oswaldo Cruz Foundation, Belo Horizonte, Brazil; School of Medicine, Universidade Federal de Minas Gerais; Belo Horizonte, Brazil.
Oswaldo Cruz Foundation, Belo Horizonte, Brazil.
Prev Med. 2021 Apr;145:106443. doi: 10.1016/j.ypmed.2021.106443. Epub 2021 Jan 28.
There is still a need for more empirical investigations to better understand the causal pathways by which neighborhood socioeconomic contexts translate into states of health. This study explored the relationship between neighborhood socioeconomic position and health, as well as the role of social cohesion, violence, places to buy healthy food, and sports and leisure spaces in mediating this relationship in a diverse set of neighborhoods in Brazil. We applied a general multiple mediation approach to analyze a cross-sectional survey of 4.046 adults living in 149 neighborhoods in 2008 and 2009. The property value was chosen as an indicator of neighborhood socioeconomic position and self-rated health as the outcome. The four mediators were constructed from the self-perception of the participants. Results: We found that people living in economically advantaged neighborhoods were less likely to report their health as being fair/poor/very poor (OR = 0.71; 95% CI = 0.63, 0.76) than people living in disadvantaged neighborhoods, and this effect was mediated by the perception of violence in the neighborhoods. On average, 8.4% of the neighborhood socioeconomic disparity in self-rated health may be explained by violence. We did not ascertain as mediators social cohesion, places to buy healthy food, and sports and leisure spaces. Violence perception mediates the relationship between neighborhood socioeconomic position and self-rated health. Targeted interventions designed to improve the health status of the population could usefully focus on reducing the level of violence in which people live.
仍需要更多实证研究，以更好地理解邻里社会经济环境转化为健康状况的因果途径。本研究探讨了邻里社会经济地位与健康之间的关系，以及社会凝聚力、暴力、购买健康食品的场所、体育和休闲空间在巴西不同邻里环境中介导这种关系的作用。我们采用了一种通用的多重中介方法，来分析2008年和2009年对居住在149个邻里的4046名成年人进行的横断面调查。选择房产价值作为邻里社会经济地位的指标，自我评估健康状况作为结果。四个中介变量是根据参与者的自我认知构建的。结果：我们发现，与生活在经济条件较差邻里的人相比，生活在经济条件较好邻里的人报告自己健康状况为一般/较差/非常差的可能性较小（OR = 0.71；95%CI = 0.63，0.76），这种影响是由对邻里暴力的认知介导的。平均而言，自我评估健康状况中邻里社会经济差异的8.4%可能由暴力来解释。我们并未确定社会凝聚力、购买健康食品的场所、体育和休闲空间为中介变量。暴力认知介导了邻里社会经济地位与自我评估健康状况之间的关系。旨在改善人群健康状况的针对性干预措施可以有效地侧重于降低人们生活环境中的暴力水平。
