Alcohol Research Group, Public Health Institute, 6001 Shellmound St. Suite 450, CA, 94608, Emeryville, USA.
BMC Public Health. 2022 Apr 15;22(1):773. doi: 10.1186/s12889-022-12938-y.
The clustering of Big Four contributors to morbidity and mortality-alcohol misuse, smoking, poor diet, and physical inactivity-may further elevate chronic health risk, but there is limited information about their specific combinations and associated health risks for racial/ethnic minority groups. We aimed to examine patterns of clustering in risk behaviors for White, Black, Hispanic, and Asian American adults and their associations with diabetes and hypertension. As these behaviors may be socioeconomically-patterned, we also examined associations between clustering and socioeconomic status (SES).
Latent class analyses and multinomial and logistic regressions were conducted using a nationally-representative sample of United States (US) adults ages 40-70 (N = 35,322) from Waves 2 (2004-2005) and 3 (2012-2013) of the National Epidemiologic Survey on Alcohol and Related Conditions. Obesity was used as a proxy for unhealthy diet. The outcomes were diabetes and hypertension.
A relatively-healthy-lifestyle class was found only among White adults. Common patterns of unhealthy clustering were found across groups with some variations: the obese-inactive class among White, Black, and Hispanic adults (and the inactive class among Asian adults); the obese-inactive-smoking class among White, Black, and Hispanic adults; the smoking-risky-drinking class among White and Hispanic adults; and the smoking-risky-drinking-inactive class among Black and Asian adults. Positive associations of unhealthier clustering (having a greater number of risk behaviors) with lower SES (i.e., family income and education) and with health conditions were more consistent for Whites than for other groups. For racial minority groups, lower education than income was more consistently associated with unhealthy clusters. The associations between unhealthier clustering and diabetes and hypertension were less clear for Blacks and Asians than for Whites, with no significant association observed for Hispanics.
Concerted efforts to address clustered risk behaviors in most US adults, particularly in racial/ethnic minority groups given the high prevalence of unhealthy clustering, are warranted.
四大主要致病因素（酗酒、吸烟、不良饮食和缺乏运动）的聚集可能会进一步增加慢性健康风险，但关于这些因素在不同种族/族裔群体中的具体组合和相关健康风险的信息有限。本研究旨在调查白种人、黑种人、西班牙裔和亚裔美国成年人的风险行为聚集模式，并评估其与糖尿病和高血压的关联。由于这些行为可能具有社会经济模式，我们还研究了聚集与社会经济地位（SES）之间的关联。
使用来自美国全国酒精流行病学调查及相关条件（NESARC）的具有全国代表性的 40-70 岁美国成年人（N=35322）的第 2 波（2004-2005 年）和第 3 波（2012-2013 年）的数据，进行潜在类别分析和多项及逻辑回归分析。肥胖被用作不健康饮食的替代指标。结局为糖尿病和高血压。
只在白种成年人中发现了相对健康的生活方式类别。在所有群体中都发现了常见的不健康聚集模式，存在一些差异：白种人、黑种人和西班牙裔成年人中的肥胖-不活跃类别（以及亚洲成年人中的不活跃类别）；白种人、黑种人和西班牙裔成年人中的肥胖-不活跃-吸烟类别；白种人和西班牙裔成年人中的吸烟-高风险饮酒类别；黑种人和亚洲成年人中的吸烟-高风险饮酒-不活跃类别。与更不健康的聚集（存在更多的风险行为）相关的 SES（即家庭收入和教育）和健康状况的正相关在白种人中比在其他群体中更为一致。对于少数族裔群体，教育程度比收入程度更一致地与不健康的聚类相关。在黑人和亚洲成年人中，与糖尿病和高血压的不健康聚类之间的关联不如白种人明显，西班牙裔成年人则没有观察到显著关联。
需要协同努力解决大多数美国成年人的风险行为聚集问题，特别是在种族/族裔少数群体中，因为不健康的聚集现象非常普遍。
