芝加哥南岸初级保健的城市空间可达性与高血压控制和知晓率：来自 COMPASS 队列的研究。
Urban Spatial Accessibility of Primary Care and Hypertension Control and Awareness on Chicago's South Side: A Study From the COMPASS Cohort.
机构信息
Institute for Population and Precision Health (J.L., M.G.K., P.Z., A.C., L.C., S.T., H.A., B.A.-K.), the University of Chicago, IL.
Department of Public Health Sciences (M.G.K., H.A., B.A.-K.), the University of Chicago, IL.
出版信息
Circ Cardiovasc Qual Outcomes. 2022 Sep;15(9):e008845. doi: 10.1161/CIRCOUTCOMES.121.008845. Epub 2022 Sep 6.
BACKGROUND
Understanding the relationship between hypertension and spatial accessibility of primary care can inform interventions to improve hypertension control and awareness, especially among disadvantaged populations. This study aims to investigate the association between spatial accessibility of primary care and hypertension control and awareness.
METHODS
Participant data from the COMPASS (Chicago Multiethnic Prevention and Surveillance Study) between 2013 and 2019 were analyzed. All participants were geocoded. Locations of primary care providers in Chicago were obtained from MAPSCorps. A score was generated for spatial accessibility of primary care using an enhanced 2-step floating catchment area method. A higher score indicates greater accessibility. Measured hypertension was defined as systolic blood pressure ≥130 mm Hg or diastolic blood pressure ≥80 mm Hg. Logistic regression was used to estimate odds ratio and 95% CI for hypertension status in relation to accessibility score quartiles.
RESULTS
Five thousand ninety-six participants (mean age, 53.4±10.8) were included. The study population was predominantly non-Hispanic black (84.0%), over 53% reported an annual household income <$15 000, and 37.3% were obese. Measured hypertension prevalence was 78.7% in this population, among which 37.7% were uncontrolled and 41.0% were unaware. A higher accessibility score was associated with lower measured hypertension prevalence. In fully adjusted models, compared with the first (lowest) quartile of accessibility score, the odds ratio strengthened from 0.82 (95% CI, 0.67-1.01) for the second quartile to 0.75 (95% CI, 0.62-0.91) for the third quartile, and further to 0.73 (95% CI, 0.60-0.89) for the fourth (highest) quartile. The increasing trend had a <0.01. Similar associations were observed for both uncontrolled and unaware hypertensions. When stratified by neighborhood socioeconomic status, a higher accessibility score was associated with lower rates of unaware hypertension in both disadvantaged and nondisadvantaged neighborhoods.
CONCLUSIONS
Better spatial accessibility of primary care is associated with improved hypertension awareness and control.
背景
了解高血压与初级保健空间可达性之间的关系，可以为改善高血压控制和知晓率提供信息，尤其是在弱势群体中。本研究旨在探讨初级保健空间可达性与高血压控制和知晓率之间的关系。
方法
分析了 2013 年至 2019 年 COMPASS（芝加哥多种族预防和监测研究）的参与者数据。所有参与者均进行地理编码。芝加哥初级保健提供者的位置从 MAPSCorps 获取。使用改进的两步浮动集水区域方法生成初级保健空间可达性评分。得分越高表示可达性越好。测量的高血压定义为收缩压≥130mmHg 或舒张压≥80mmHg。使用逻辑回归估计与可达性评分四分位相关的高血压状态的比值比和 95%置信区间。
结果
纳入了 5096 名参与者（平均年龄 53.4±10.8）。研究人群主要是非西班牙裔黑人（84.0%），超过 53%的人报告年收入<15000 美元，37.3%的人肥胖。该人群中测量的高血压患病率为 78.7%，其中 37.7%未得到控制，41.0%未被发现。更高的可达性评分与较低的测量高血压患病率相关。在完全调整的模型中，与可达性评分最低的第一四分位数相比，第二四分位数的比值比从 0.82（95%置信区间，0.67-1.01）增强到第三四分位数的 0.75（95%置信区间，0.62-0.91），进一步增强到第四四分位数（最高）的 0.73（95%置信区间，0.60-0.89）。这种递增趋势<0.01。未控制和未察觉的高血压也观察到类似的关联。当按邻里社会经济地位分层时，在贫困和非贫困邻里中，更高的可达性评分与较低的未察觉高血压率相关。
结论
初级保健的空间可达性更好与高血压意识和控制的提高有关。
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