Blasingame Miaya, Samuels Lauren R, Heerman William J
Vanderbilt University School of Medicine, Nashville, TN, USA.
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
Child Obes. 2024 Mar;20(2):107-118. doi: 10.1089/chi.2022.0222. Epub 2023 Mar 29.
To characterize the association between multiple social determinants of health (SDOH) and overweight and obesity among US children. We conducted a cross-sectional analysis using the 2016-2020 National Survey of Children's Health. SDOH domains consisted of Economic Stability, Social and Community Context, Neighborhood and Built Environment, and Health Care Access and Quality. We used ordinal logistic regression to model associations between SDOH and weight status and calculate predicted probabilities of having overweight or obesity for various SDOH profiles. Data from 81,716 children represented a weighted sample of 29,415,016 children ages 10-17 years in the United States. Of these, 17% had overweight and 17% had obesity. Compared with children with the theoretically lowest-risk SDOH profile, children with the highest-risk SDOH profiles in all four domains had an odds ratio of having a higher BMI category of 4.38 (95% confidence interval 1.67-7.09). For the lowest risk profile, the predicted probability of obesity varied from 8% to 11%, depending on race. For the highest risk profile, the predicted probability of obesity varied from 26% to 34%, depending on race. While high-risk values in each SDOH domain were associated with higher predicted probability of overweight and obesity, it was the combination of highest risk values in all the SDOH domains that led to greatest increases. This suggests a complex and multilayered relationship between the SDOH and childhood obesity, necessitating a comprehensive approach to addressing health equity to reduce childhood obesity.
为了描述美国儿童多种健康社会决定因素（SDOH）与超重和肥胖之间的关联。我们使用2016 - 2020年全国儿童健康调查进行了横断面分析。SDOH领域包括经济稳定性、社会和社区环境、邻里和建筑环境以及医疗保健可及性和质量。我们使用有序逻辑回归来建立SDOH与体重状况之间的关联模型，并计算各种SDOH概况下超重或肥胖的预测概率。来自81,716名儿童的数据代表了美国29,415,016名10 - 17岁儿童的加权样本。其中，17%的儿童超重，17%的儿童肥胖。与理论上风险最低的SDOH概况的儿童相比，所有四个领域中风险最高的SDOH概况的儿童BMI类别较高的优势比为4.38（95%置信区间1.67 - 7.09）。对于风险最低的概况，肥胖的预测概率因种族而异，从8%到11%不等。对于风险最高的概况，肥胖的预测概率因种族而异，从26%到34%不等。虽然每个SDOH领域的高风险值都与超重和肥胖的较高预测概率相关，但所有SDOH领域中最高风险值的组合导致了最大的增加。这表明SDOH与儿童肥胖之间存在复杂且多层次的关系，需要采取综合方法来解决健康公平问题以减少儿童肥胖。
