Association of Long-Term Trajectories of Neighborhood Socioeconomic Status With Weight Change in Older Adults.
Association of Long-Term Trajectories of Neighborhood Socioeconomic Status With Weight Change in Older Adults.
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DOI：
10.1001/jamanetworkopen.2020.36809
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发表时间：
2021-02-01
影响因子：
13.8
通讯作者：
Xiao Q
中科院分区：
文献类型：
--
作者：
Zhang D;Bauer C;Powell-Wiley T;Xiao Q
该队列研究了社区社会经济地位的变化与老年人体重过度增加和减少之间的关系。社区社会经济地位（SES）变化与老年人体重变化之间有什么联系？在这项对126179名美国成年人进行的队列研究中，社区SES的长期改善与体重过度增加和过度减轻的风险降低相关，而长期社区SES下降与这些结果的风险升高相关。存在剂量依赖性关联，观察到较大的邻近变化的风险变化较大。这项研究发现，持续的邻里变化与老年人体重结果的显着差异有关。研究社区社会经济地位（SES）的长期变化可能有助于更好地了解社区暴露与体重结果之间的关联，并提供支持社区干预的证据。以前很少有研究来研究社区SES和体重减轻之间的关系，这是一个与老年人健康状况不佳相关的风险因素。确定社区SES的改善是否与体重过度增加和过度减轻的可能性降低相关，以及下降是否与这些体重结果的可能性增加相关。这项队列研究使用了美国国立卫生研究院-AARP（以前称为美国退休人员协会）饮食与健康研究（1995-2006）的数据。该分析包括一个由126179名成年人（年龄在50-71岁之间）组成的队列，其基线（1995-1996年）的社区与随访（2004-2006年）相同。所有分析均在2018年12月至2020年12月期间进行。居住在经历了8个社区SES轨迹中的1个的社区，该轨迹是根据使用美国人口普查和美国社区调查数据创建的全国社区SES指数定义的。8个轨迹组，其中高或H表示排名在或高于特定年份的样本中位数，低或L表示排名低于中位数，为HHH（即1990年高位到2000年高位到2010年高位），或稳定高位; HLL，或前期下跌; HHL，或后期下跌; HLH，或短暂下跌; LLL，或稳定低位; LHH，或早期改善; LLH，或晚期改善;和LHL，或一过性改善。体重过度增加和减轻定义为增加或减轻基线体重的10%或以上。在126179名成人中，76225名（60.4%）为男性，平均（SD）年龄为62.1（5.3）岁。社区SES的改善与随访期间体重过度增加和体重减轻的可能性较低相关，而社区SES的下降与体重过度增加和体重减轻的可能性较高相关。与稳定低水平组相比，早期改善组体重过度增加的风险显著降低（比值比[OR]，0.87; 95%CI，0.79-0.95），晚期改善组体重过度减轻的风险显著降低（OR，0.89; 95%CI，0.80-1.00）。与稳定高值组相比，早期下降组（OR，1.19; 95%CI，1.08-1.31）和晚期下降组（OR，1.13; 95%CI，1.04-1.24）体重过度增加的风险显著增加，早期下降组体重过度减轻的风险显著增加（OR，1.15; 95%CI，1.02-1.28）。当研究早期（即1990-2000年）社区SES改善或下降，并在整个随访期间得到证实（即早期下降组和早期改善组）时，可能性增加更大。总体而言，我们发现社区SES的变化与体重结果之间存在线性相关性，其中社区SES每下降5个百分点，体重过度增加或减轻的风险就会增加1.2%至2.4%（体重过度增加：女性OR，1.01; 95% CI，1.00-1.02;男性OR，1.02; 95% CI，1.01-1.03;体重过度减轻：女性OR，1.02; 95% CI，1.01-1.03;女性OR，1.02;男性的95%CI为1.01-1.03;趋势P < .0001）。这些发现表明，改变邻里环境与老年人体重状况的变化有关。
This cohort examines the association of changes in neighborhood socioeconomic status with excessive weight gain and loss among older adults. What is the association between neighborhood socioeconomic status (SES) change and weight change among older adults? In this cohort study of 126 179 US adults, long-term improvement in neighborhood SES was associated with lower risk for excessive weight gain and excessive weight loss, while long-term neighborhood SES decline was associated with higher risks for these outcomes. There was a dose-dependent association, with larger changes in risk observed with larger neighborhood changes. This study found that sustained neighborhood changes were associated with significant differences in weight outcomes among older adults. Studying long-term changes in neighborhood socioeconomic status (SES) may help to better understand the associations between neighborhood exposure and weight outcomes and provide evidence supporting neighborhood interventions. Little previous research has been done to examine associations between neighborhood SES and weight loss, a risk factor associated with poor health outcomes in the older population. To determine whether improvements in neighborhood SES are associated with reduced likelihoods of excessive weight gain and excessive weight loss and whether declines are associated with increased likelihoods of these weight outcomes. This cohort study was conducted using data from the National Institutes of Health-AARP (formerly known as the American Association of Retired Persons) Diet and Health study (1995-2006). The analysis included a cohort of 126 179 adults (aged 50-71 years) whose neighborhoods at baseline (1995-1996) were the same as at follow-up (2004-2006). All analyses were performed from December 2018 through December 2020. Living in a neighborhood that experienced 1 of 8 neighborhood SES trajectories defined based on a national neighborhood SES index created using data from the US Census and American Community Survey. The 8 trajectory groups, in which high, or H, indicated rankings at or above the sample median of a specific year and low, or L, indicated rankings below the median, were HHH (ie, high in 1990 to high in 2000 to high in 2010), or stable high; HLL, or early decline; HHL, or late decline; HLH, or transient decline; LLL, or stable low; LHH, or early improvement; LLH, or late improvement; and LHL, or transient improvement. Excessive weight gain and loss were defined as gaining or losing 10% or more of baseline weight. Among 126 179 adults, 76 225 (60.4%) were men and the mean (SD) age was 62.1 (5.3) years. Improvements in neighborhood SES were associated with lower likelihoods of excessive weight gain and weight loss over follow-up, while declines in neighborhood SES were associated with higher likelihoods of excessive weight gain and weight loss. Compared with the stable low group, the risk was significantly reduced for excessive weight gain in the early improvement group (odds ratio [OR], 0.87; 95% CI, 0.79-0.95) and for excessive weight loss in the late improvement group (OR, 0.89; 95% CI, 0.80-1.00). Compared with the stable high group, the risk of excessive weight gain was significantly increased for the early decline group (OR, 1.19; 95% CI, 1.08-1.31) and late decline group (OR, 1.13; 95% CI, 1.04-1.24) and for excessive weight loss in the early decline group (OR, 1.15; 95% CI, 1.02-1.28). The increases in likelihood were greater when the improvement or decline in neighborhood SES occurred early in the study period (ie, 1990-2000) and was substantiated throughout the follow-up (ie, the early decline and early improvement groups). Overall, we found a linear association between changes in neighborhood SES and weight outcomes, in which every 5 percentile decline in neighborhood SES was associated with a 1.2% to 2.4% increase in the risk of excessive weight gain or loss (excessive weight gain: OR, 1.01; 95% CI, 1.00-1.02 for women; OR, 1.02; 95% CI, 1.01-1.03 for men; excessive weight loss: OR, 1.02; 95% CI, 1.01-1.03 for women; OR, 1.02; 95% CI, 1.01-1.03 for men; P for- trend < .0001). These findings suggest that changing neighborhood environment was associated with changes in weight status in older adults.
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