Neighbourhood environments and mortality in an elderly cohort: results from the cardiovascular health study
Neighbourhood environments and mortality in an elderly cohort: results from the cardiovascular health study
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DOI：
10.1136/jech.2003.019596
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发表时间：
2004-11-01
影响因子：
6.3
通讯作者：
Schultz, R
中科院分区：
文献类型：
--
作者：
Roux, AVD;Borrell, LN;Schultz, R
背景资料：据推测，邻里条件与老年人口的健康，但纵向研究是罕见的，混杂的个人水平变量仍然是possibility.Methods：数据来自心血管健康研究，人口为基础的研究，年龄在65岁及以上的成年人。人口普查街区组被用作邻里的代理。一个总结分数被用来衡量邻里的社会经济环境。从基线检查中获得有关个人社会经济指标、心血管疾病患病率和心血管危险因素的信息。比例风险回归和倾向评分匹配被用来控制个人水平variables.Results：在8年的随访中，有1346人死亡的5074名参与者，其中43%是由于心血管疾病。在白色参与者中，生活在最弱势社区组与较高的心血管死亡率相关，经收入，教育和职业调整后（风险比（HR）1.5，95%置信区间（CI）1.2至1.9）。未观察到非心血管死亡的邻里差异。黑人参与者的心血管死亡估计值为1.3（95% CI 0.7至2.3），非心血管死亡估计值为1.4（95% CI 0.8至2.4），但样本量较小。在白色受试者中，在校正了流行基线疾病和心血管危险因素后，邻里特征与心血管死亡率的相关性仍然存在。使用倾向评分匹配导致类似的结果（HR最低与最高的邻里得分组：1.6 95%CI 1.1至2.5，控制个人的社会经济指标）。结论：邻里的劣势与老年白色成人心血管死亡率。
Background: It has been postulated that neighbourhood conditions are related to the health of the elderly population but longitudinal studies are rare and confounding by individual level variables remains a possibility.Methods: Data were obtained from the cardiovascular health study, a population based study of adults aged 65 years and older. Census block groups were used as proxies for neighbourhoods. A summary score was used to characterise the neighbourhood socioeconomic environment. Information on personal socioeconomic indicators, cardiovascular disease prevalence, and cardiovascular risk factors was obtained from the baseline examination. Proportional hazards regression and propensity score matching were used to control for individual level variables.Results: Over the eight year follow up there were 1346 deaths among the 5074 participants, of which 43% were attributable to cardiovascular disease. Among white participants, living in the most disadvantaged neighbourhood group was associated with higher rates of cardiovascular death, after adjustment for income, education, and occupation ( hazard ratio (HR) 1.5, 95% confidence intervals (CI) 1.2 to 1.9). No neighbourhood differences were observed for non-cardiovascular deaths. Estimates for black participants were 1.3 ( 95% CI 0.7 to 2.3) for cardiovascular deaths and 1.4 ( 95% CI 0.8 to 2.4) for non-cardiovascular deaths, but sample size was small. In white participants, associations of neighbourhood characteristics with cardiovascular mortality persisted after adjustment for prevalent baseline disease and cardiovascular risk factors. The use of propensity score matching led to similar results ( HR for the lowest compared with the highest neighbourhood score group: 1.6 95% CI 1.1 to 2.5, controlling for personal socioeconomic indicators).Conclusion: Neighbourhood disadvantage is related to rates of cardiovascular death in elderly white adults.