A Closer Look at Rural-Urban Health Disparities: Associations Between Obesity and Rurality Vary by Geospatial and Sociodemographic Factors
A Closer Look at Rural-Urban Health Disparities: Associations Between Obesity and Rurality Vary by Geospatial and Sociodemographic Factors
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DOI：
10.1111/jrh.12207
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发表时间：
2017-03-01
影响因子：
4.9
通讯作者：
Sando, Trisha A.
中科院分区：
文献类型：
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作者：
Cohen, Steven A.;Cook, Sarah K.;Sando, Trisha A.
背景：肥胖影响着美国超过三分之一的老年人。衰老和肥胖都增加了慢性病、早期死亡和额外医疗保健利用的风险。农村地区的肥胖率高于城市地区，尽管调查结果喜忧参半。本研究的目的是评估农村与肥胖之间的潜在非线性关系，并评估社会经济地位和地理区域对农村与肥胖之间关系的调节作用。使用行为风险因素监测系统中65岁及以上的成年人的代表性样本，肥胖（BMI >= 30 kg/m2）的模型是根据农村-城市状况的主要暴露量建立的，通过相对农村化指数来衡量。二元逻辑回归模型被用来估计肥胖的几率农村都作为一个连续变量和农村的十分位数。然后，按人均收入和状态分层模型，以评估潜在的适度通过这些factors.Results：在老年人肥胖的患病率是最高的中间农村地区（OR在农村十分位数#5 1.134，95%CI：1.086-1.184）和最低的最农村和最城市地区。肥胖症在低收入和中等收入地区是最高的，无论城乡地位如何。在高收入地区，老年人肥胖在中等农村地区最高，在大多数农村地区最低（OR 0.726，95%CI：0.606-0.870）和更多的城市地区，显示出J形关联。有很大的差异，农村和肥胖之间的关联在老年人之间的states.Conclusion：农村和肥胖之间的关联不同程度的农村，社会经济地位和地理。因此，减少老年人城乡健康差距的传统“一刀切”办法，如果针对具体地区的城乡健康梯度，可能会更有效。
Background: Obesity affects over one-third of older adults in the United States. Both aging and obesity contribute to an increased risk for chronic disease, early mortality, and additional health care utilization. Obesity rates are higher in rural areas than in urban areas, although findings are mixed. The objectives of this study are to assess potential nonlinearity in the association between rurality and obesity, and to evaluate the potential for socioeconomic status and geographic area to moderate the associations between rurality and obesity.Methods: Using a representative sample of adults aged 65 and above from the Behavioral Risk Factor Surveillance System, obesity (BMI >= 30 kg/m(2)) was modeled against the primary exposure of rural-urban status, as measured by the Index of Relative Rurality. Binary logistic regression models were used to estimate the odds of obesity by rurality both as a continuous variable and by decile of rurality. Models were then stratified by per-capita income and state to assess potential moderation by these factors.Results: The prevalence of obesity in older adults was highest in intermediate rurality areas (OR in rurality decile #5 1.134, 95% CI: 1.086-1.184) and lowest in the most rural and most urban areas. Obesity was highest in low-and middle-income areas, regardless of rural-urban status. In high-income areas, obesity among older adults was highest in areas of intermediate rurality and lowest in the most rural areas (OR 0.726, 95% CI: 0.606-0.870) and more urban areas, showing a J-shaped association. There were substantial differences in the associations between rurality and obesity in older adults among states.Conclusion: Associations between rurality and obesity varied by degree of rurality, socioeconomic status, and geography. Therefore, traditional "one-size-fits-all" approaches to reducing rural-urban health disparities in older adults may be more effective if tailored to the area-specific rural-urban gradients in health.