The influence of neighborhood environment on the incidence of childhood, asthma: a multilevel approach
The influence of neighborhood environment on the incidence of childhood, asthma: a multilevel approach
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DOI：
10.1016/j.socscimed.2004.11.034
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发表时间：
2005-06-01
影响因子：
5.4
通讯作者：
Yunginger, J
中科院分区：
文献类型：
--
作者：
Juhn, YJ;St Sauver, J;Yunginger, J
一些生态学分析表明，邻里环境对哮喘的影响。然而，没有以前的研究已经应用了多层次的方法来评估的生态环境对儿童哮喘的发病率占个别危险因素的影响。本研究评估了1976年至1979年间出生于明尼苏达州罗切斯特的所有儿童中，社区和个人水平因素对儿童哮喘发病率的影响。我们在1976年至1983年期间出生于罗切斯特的所有儿童中确定了哮喘患者。我们应用了一个多层次的生存模型的脆弱性，以评估社区特征的影响，如平均家庭收入每个人口普查区（n = 16）从1980年的人口普查报告和状态的人口普查区是否面临主要公路或铁路的交叉口，哮喘发病率。调整个体水平协变量（包括性别、出生体重、母亲出生时年龄和父母出生时受教育程度）后，计算社区社会经济地位（SES）、人口普查区是否与公路或铁路交叉的相对危险度（RR）以及人口普查区随机效应的方差。我们发现，居住在人口普查区与公路或铁路交叉口的儿童发生哮喘的RR为1. 6（95% CI：1。1-2.2）相比，那些谁住在人口普查区不面对十字路口，调整个人和邻里水平的协变量。归因于人口普查区的脆弱项的方差很小（0.0085），并通过添加邻域协变量进行了修改（从0.004到0.0085，112%的变化）。个体水平因素对哮喘发病率的总体影响与社区环境无关。在非市中心的环境中，如明尼苏达州的罗切斯特，邻里环境对儿童哮喘的影响很小。在评估聚类的随机效应时，需要考虑将相关的邻域水平协变量纳入多水平模型。(c)2004爱思唯尔有限公司保留所有权利。
Some ecological analyses suggest an influence of neighborhood environment on asthma outcomes. However, no previous study has applied a multilevel approach to assess an ecological effect of neighborhood environment on the incidence of childhood asthma accounting for individual risk factors. This study assessed the influence of neighborhood and individual-level factors on the incidence of childhood asthma among all children born in Rochester, Minnesota, between 1976 and 1979. We identified asthmatics among all children born in Rochester, between 1976 and 1983. We applied a multilevel survival model with the frailty term to assess the effects of neighborhood characteristics, such as mean family income per census tract (n = 16) from the 1980 census report and the status of whether a census tract faces intersections with major highways or railroads, on asthma incidence. The relative risks (RR) of neighborhood socioeconomic status (SES), the status of whether census tracts face intersections with highways or railroads and the variance of random effect of census tracts were calculated adjusting individual-level covariates for asthma, including gender, birth weight, mother's age at birth and parental educational level at birth. We found that the RR of developing asthma among children living in census tracts facing intersections with highways or railroads was 1.6 (95 % CI: 1. 1-2.2) compared to those who lived in census tracts not facing intersections, adjusting individual- and neighborhood-level covariates. The variance of the frailty term attributable to census tracts was small (0.0085) and was modified (from 0.004 to 0.0085, 112% change) by adding neighborhood covariates-. The overall effects of individual-level factors on asthma incidence were independent of neighborhood environment. The influence of neighborhood environment on childhood asthma in a non-inner-city setting, like Rochester, Minnesota, was small to modest. Incorporating pertinent neighborhood-level covariates into multilevel models needs to be considered in assessing the random effect of clusters. (c) 2004 Elsevier Ltd. All rights reserved.