Diez-Roux A V, Nieto F J, Muntaner C, Tyroler H A, Comstock G W, Shahar E, Cooper L S, Watson R L, Szklo M
Division of General Medicine, Columbia College of Physicians and Surgeons, Columbia University School of Public Health, New York, NY, USA.
Am J Epidemiol. 1997 Jul 1;146(1):48-63. doi: 10.1093/oxfordjournals.aje.a009191.
The authors investigated whether neighborhood socioeconomic characteristics are associated with coronary heart disease prevalence and risk factors, whether these associations persist after adjustment for individual-level social class indicators, and whether the effects of individual-level indicators vary across neighborhoods. The study sample consisted of 12,601 persons in four US communities (Washington County, Maryland; Forsyth County, North Carolina; Minneapolis, Minnesota; and Jackson, Mississippi) participating in the baseline examination of the Atherosclerosis Risk in Communities Study (1987-1989). Neighborhood characteristics were obtained from 1990 US Census block-group measures. Multilevel models were used to estimate associations with neighborhood variables after adjustment for individual-level indicators of social class. Living in deprived neighborhoods was associated with increased prevalence of coronary heart disease and increased levels of risk factors, with associations generally persisting after adjustment for individual-level variables. Inconsistent associations were documented for serum cholesterol and disease prevalence in African-American men. For Jackson African-American men living in poor neighborhoods, coronary heart disease prevalence decreased as neighborhood characteristics worsened. Additionally, in African-American men from Jackson, low social class was associated with increased serum cholesterol in "richer" neighborhoods but decreased serum cholesterol in "poorer" neighborhoods. Neighborhood environments may be one of the pathways through which social structure shapes coronary heart disease risk.
作者们研究了社区社会经济特征是否与冠心病患病率及危险因素相关，在对个体层面的社会阶层指标进行调整后这些关联是否依然存在，以及个体层面指标的影响在不同社区之间是否存在差异。研究样本包括来自美国四个社区（马里兰州华盛顿县；北卡罗来纳州福赛斯县；明尼苏达州明尼阿波利斯市；密西西比州杰克逊市）的12,601人，他们参与了社区动脉粥样硬化风险研究的基线检查（1987 - 1989年）。社区特征取自1990年美国人口普查街区组数据。在对个体层面的社会阶层指标进行调整后，使用多水平模型来估计与社区变量的关联。生活在贫困社区与冠心病患病率增加及危险因素水平升高相关，在对个体层面变量进行调整后，这些关联通常依然存在。非裔美国男性的血清胆固醇与疾病患病率之间的关联并不一致。对于生活在贫困社区的杰克逊非裔美国男性，随着社区特征变差，冠心病患病率下降。此外，在来自杰克逊的非裔美国男性中，低社会阶层在“较富裕”社区与血清胆固醇升高相关，但在“较贫困”社区与血清胆固醇降低相关。社区环境可能是社会结构影响冠心病风险的途径之一。
