Neighborhood Contributions to Racial and Ethnic Disparities in Obesity Among New York City Adults
Neighborhood Contributions to Racial and Ethnic Disparities in Obesity Among New York City Adults
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DOI：
10.2105/ajph.2013.301782
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发表时间：
2015-01-01
影响因子：
12.7
通讯作者：
Harris, Tiffany G.
中科院分区：
文献类型：
--
作者：
Lim, Sungwoo;Harris, Tiffany G.
目标。在考虑了复杂的抽样后，我们评估了社区对纽约市成年人种族/民族肥胖差异的混淆，以及社区因素(步行能力、黑人或西班牙裔比例、贫困)对这种影响的影响。我们结合了纽约市社区健康调查2002-2004年的数据和2000年人口普查邮政编码级别的数据。我们通过两组回归分析估计了肥胖的优势比(OR)。首先，我们使用了将条件伪似然方法引入复样本平差的方法。其次，我们比较了每个邻里因素的传统多水平模型和混合固定效应模型中种族/民族的OR。当我们控制邻里混杂(OR=1.4；95%可信区间=1.2，1.6；第一次分析)时，黑人和白人对肥胖的加权估计(OR=1.8；95%可信区间=1.6，2.0)被减弱。社区黑人所占比例贡献较大，步行能力贡献最小(二次分析)。纽约市社区的黑人比例在很大程度上解释了黑人和白人之间肥胖率的差异。这项研究强调了评估有效的社区影响对公共卫生监测和干预的重要性。
Objectives. We assessed neighborhood confounding on racial/ethnic obesity disparities among adults in New York City after accounting for complex sampling, and how much neighborhood factors (walkability, percentage Black or Hispanic, poverty) contributed to this effect.Methods. We combined New York City Community Health Survey 2002-2004 data with Census 2000 zip code-level data. We estimated odds ratios (ORs) for obesity with 2 sets of regression analyses. First, we used the method incorporating the conditional pseudolikelihood into complex sample adjustment. Second, we compared ORs for race/ethnicity from a conventional multilevel model for each neighborhood factor with those from a hybrid fixed-effect model.Results. The weighted estimate for obesity for Blacks versus Whites (OR = 1.8; 95% confidence interval = 1.6, 2.0) was attenuated when we controlled neighborhood confounding (OR = 1.4; 95% confidence interval = 1.2, 1.6; first analysis). Percentage of Blacks in the neighborhood made a large contribution whereas the walkability contribution was minimal (second analysis).Conclusions. Percentage of Blacks in New York City neighborhoods explained a large portion of the disparity in obesity between Blacks and Whites. The study highlights the importance of estimating valid neighborhood effects for public health surveillance and intervention.