The link between neighborhood poverty and health: Context or composition?
The link between neighborhood poverty and health: Context or composition?
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DOI：
10.1093/aje/kwn182
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发表时间：
2008-09-15
影响因子：
5
通讯作者：
Finch, Brian Karl
中科院分区：
文献类型：
--
作者：
Do, D. Phuong;Finch, Brian Karl
邻里环境和健康的横断面研究由于未观察到异质性而受到向上偏倚的影响，并且由于过度调整邻里环境和健康之间通路中的潜在中介而受到向下偏倚的影响。在这项研究中，作者采用了两种策略来解决这两个偏见来源。首先，为了减轻中介的过度调整，他们使用组合倾向评分和回归策略，调整了在测量邻里背景之前观察到的基线特征。其次，为了减轻未测量混杂因素的调整不足，他们采用了固定效应建模策略来解释未观察到的非时变异质性。分析基于收入动态小组研究（1980-1997）中具有全国代表性的非移民美国人口样本，在该样本中，受访者对健康状况的评价与社区贫困程度进行了回归。对于倾向得分/回归模型，样本包括大约6,000名受访者，对于固定效应模型，样本包括45,000人年。这两种建模策略都对社区贫困进行了重大估计，并支持社区环境与健康之间的因果关系。
Cross-sectional studies of neighborhood context and health are subject to upward bias due to unobserved heterogeneity and to downward bias due to overadjustment for potential mediators in the pathway between neighborhood context and health. In this study, the authors employed two strategies that addressed these two sources of bias. First, to mitigate overadjustment of mediators, they adjusted for baseline characteristics observed just prior to the measurement of neighborhood context, using a combined propensity score and regression strategy. Second, to mitigate underadjustment of unmeasured confounders, they employed a fixed-effects modeling strategy to account for unobserved non-time-varying heterogeneity. Analyses were based on a nationally representative sample of the nonimmigrant US population from the Panel Study of Income Dynamics (1980-1997) in which respondent-rated health was regressed on neighborhood poverty. The samples consisted of approximately 6,000 respondents for the propensity score/regression models and 45,000 person-years for the fixed-effects models. Both modeling strategies yielded significant estimates of neighborhood poverty and supported a causal link between neighborhood context and health.