Neighborhood Environmental Health and Premature Death From Cardiovascular Disease
Neighborhood Environmental Health and Premature Death From Cardiovascular Disease
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DOI：
10.5888/pcd15.170220
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发表时间：
2018-02-01
影响因子：
5.5
通讯作者：
Akintobi, Tabia Henry
中科院分区：
文献类型：
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作者：
Gaglioti, Anne H.;Xu, Junjun;Akintobi, Tabia Henry
在美国，心血管疾病（CVD）是导致死亡的主要原因，并且对种族/少数民族群体的影响不成比例。健康的社区条件与减少心血管疾病风险的健康行为的增加有关，但少数民族社区往往缺乏食物获取和步行能力。这项研究验证了社区驱动的假设，即社区层面的食物获取困难和社区步行能力差与心血管疾病导致过早死亡的种族差异有关。方法采用多变量logistic回归模型研究了亚特兰大人口普查区水平上社区食物获取和步行能力对心血管疾病过早死亡率的影响。我们制作了地图来说明城市人口普查区的过早心血管疾病死亡率，食物获取和步行性。结果我们发现，亚特兰大人口普查区的心血管疾病过早死亡率存在显著的种族差异，食物获取和步行能力存在显著的地理差异。在未调整的模型中，改善食物获取和步行能力与降低总体过早心血管疾病死亡率相关，但在针对人口构成和贫困进行调整的模型中，这种关联并不存在。少数民族人口高度集中的人口普查区有较高的食物获取困难、步行能力差和心血管疾病过早死亡率。结论本研究突出了亚特兰大人口普查区水平上心血管疾病过早死亡率、社区食物获取和步行能力的差异。改善食物获取可能会对生活在同一地区的亚种群产生不同的影响。这些结果可用于校准社区一级的干预措施，并强调需要检查种族特定的健康结果。
IntroductionCardiovascular disease (CVD) is the leading cause of death in the United States and disproportionately affects racial/ethnic minority groups. Healthy neighborhood conditions are associated with increased uptake of health behaviors that reduce CVD risk, but minority neighborhoods often have poor food access and poor walkability. This study tested the community-driven hypothesis that poor access to food at the neighborhood level and poor neighborhood walkability are associated with racial disparities in premature deaths from CVD.MethodsWe examined the relationship between neighborhood-level food access and walkability on premature CVD mortality rates at the census tract level for the city of Atlanta using multivariable logistic regression models. We produced maps to illustrate premature CVD mortality, food access, and walkability by census tract for the city.ResultsWe found significant racial differences in premature CVD mortality rates and geographic disparities in food access and walkability among census tracts in Atlanta. Improved food access and walkability were associated with reduced overall premature CVD mortality in unadjusted models, but this association did not persist in models adjusted for census tract population composition and poverty. Census tracts with high concentrations of minority populations had higher levels of poor food access, poor walkability, and premature CVD mortality.ConclusionThis study highlights disparities in premature CVD mortality and neighborhood food access and walkability at the census tract level in the city of Atlanta. Improving food access may have differential effects for subpopulations living in the same area. These results can be used to calibrate neighborhood-level interventions, and they highlight the need to examine race-specific health outcomes.