Yan Lily D, McNairy Margaret L, Dévieux Jessy G, Pierre Jean Lookens, Dade Eliezer, Sufra Rodney, Gerber Linda M, Roberts Nicholas, St Preux Stephano, Malebranche Rodolphe, Metz Miranda, Tymejczyk Olga, Nash Denis, Deschamps Marie, Safford Monica M, Pape Jean W, Rouzier Vanessa
Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America.
Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America.
PLOS Glob Public Health. 2022;2(7). doi: 10.1371/journal.pgph.0000503. Epub 2022 Jul 27.
Neighborhood factors have been associated with health outcomes, but this relationship is underexplored in low-income countries like Haiti. We describe perceived neighborhood cohesion and perceived violence using the Neighborhood Collective Efficacy and the City Stress Inventory scores. We hypothesized lower cohesion and higher violence were associated with higher stress, depression, and hypertension. We collected data from a population-based cohort of adults in Port-au-Prince, Haiti between March 2019 to August 2021, including stress (Perceived Stress Scale), depression (PHQ-9), and blood pressure (BP). Hypertension was defined as systolic BP ≥ 140 mmHg, diastolic BP ≥ 90 mmHg, or on antihypertensive medications. Covariates that were adjusted for included age, sex, body mass index, smoking, alcohol, physical activity, diet, income, and education, multivariable linear and Poisson regressions assessed the relationship between exposures and outcomes. Among 2,961 adults, 58.0% were female and median age was 40 years (IQR:28-55). Participants reported high cohesion (median 15/25, IQR:14-17) and moderate violence (9/20, IQR:7-11). Stress was moderate (8/16) and 12.6% had at least moderate depression (PHQ-9 ≥ 11). Median systolic BP was 118 mmHg, median diastolic BP 72 mmHg, and 29.2% had hypertension. In regressions, higher violence was associated with higher prevalence ratios of moderate-to-severe depression (Tertile3 vs Tertile1: PR 1.12, 95%CI:1.09 to 1.16) and stress (+0.3 score, 95%CI:0.01 to 0.6) but not hypertension. Cohesion was associated with lower stress (Tertile3 vs Tertile1: -0.4 score, 95%CI: -0.7 to -0.2) but not depression or hypertension. In summary, urban Haitians reported high perceived cohesion and moderate violence, with higher violence associated with higher stress and depression.
邻里因素与健康结果相关，但在海地等低收入国家，这种关系尚未得到充分研究。我们使用邻里集体效能感和城市压力量表得分来描述感知到的邻里凝聚力和暴力情况。我们假设较低的凝聚力和较高的暴力与更高的压力、抑郁和高血压有关。我们在2019年3月至2021年8月期间从海地太子港的一个基于人群的成年队列中收集了数据，包括压力（感知压力量表）、抑郁（PHQ-9）和血压（BP）。高血压定义为收缩压≥140 mmHg、舒张压≥90 mmHg或正在服用降压药物。调整的协变量包括年龄、性别、体重指数、吸烟、饮酒、体育活动、饮食、收入和教育，多变量线性回归和泊松回归评估了暴露因素与结果之间的关系。在2961名成年人中，58.0%为女性，中位年龄为40岁（四分位间距：28 - 55岁）。参与者报告的凝聚力较高（中位数为15/25，四分位间距：14 - 17），暴力程度中等（9/20，四分位间距：7 - 11）。压力为中等水平（8/16），12.6%的人至少有中度抑郁（PHQ-9≥11）。收缩压中位数为118 mmHg，舒张压中位数为72 mmHg，29.2%的人患有高血压。在回归分析中，较高的暴力与中度至重度抑郁的患病率较高相关（第三分位数与第一分位数相比：PR 1.12，95%置信区间：1.09至1.16）和压力增加（+0.3分，95%置信区间：0.01至0.6），但与高血压无关。凝聚力与较低的压力相关（第三分位数与第一分位数相比：-0.4分，95%置信区间：-0.7至-0.2），但与抑郁或高血压无关。总之，海地城市居民报告的感知凝聚力较高，暴力程度中等，较高的暴力与较高的压力和抑郁相关。
