Changes in diagnosed diabetes, obesity, and physical inactivity prevalence in US counties, 2004-2012.
Changes in diagnosed diabetes, obesity, and physical inactivity prevalence in US counties, 2004-2012.
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DOI：
10.1371/journal.pone.0173428
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Gregg EW
中科院分区：
文献类型：
--
作者：
Geiss LS;Kirtland K;Lin J;Shrestha S;Thompson T;Albright A;Gregg EW
最近的研究表明，美国确诊糖尿病的患病率在2008年左右达到了一个平台或放缓，这种变化与肥胖平台和体力活动的增加相吻合。然而，国家估计数可能掩盖地理分组的重要差异。我们研究了在美国的3143个县中，诊断出的糖尿病、肥胖和闲暇时间身体不活动的患病率是否也在放缓或趋于平稳。我们使用了由疾病控制和预防中心（CDC）生成的经诊断的糖尿病、肥胖和休闲时间身体活动不足的年龄调整患病率的公开县估计值。使用贝叶斯多水平回归，包括按县和年份的随机效应，并应用三次样条来平滑这些估计值，我们估计了2004年至2008年和2008年至2012年每个县糖尿病，肥胖和身体活动不足患病率的平均年百分比变化（APPC）。与2004-2008年相比，2008-2012年糖尿病、肥胖和缺乏体力活动的中位APPC较低（糖尿病APPC差异= 0.16，95%CI 0.14，0.18;肥胖APPC差异= 0.65，95%CI 0.59，0.70;缺乏体力活动APPC差异= 0.43，95%CI 0.37，0.48）。APPC和APPC的时间段之间的差异因县和美国地区而异。尽管有所改善，但这些风险因素的水平仍然很高，大多数州只是放缓而不是逆转，这表明所有州都可能受益于这些风险因素的减少。这些风险因素在各州的流行轨迹各不相同，突出表明继续需要确定高风险地区和人群，以便采取预防性干预措施。了解这些因素如何变化可能有助于当地政策制定者确定目标并跟踪减少糖尿病、肥胖和缺乏身体活动的努力的影响。
Recent studies suggest that prevalence of diagnosed diabetes in the United States reached a plateau or slowed around 2008, and that this change coincided with obesity plateaus and increases in physical activity. However, national estimates can obscure important variations in geographic subgroups. We examine whether a slowing or leveling off in diagnosed diabetes, obesity, and leisure time physical inactivity prevalence is also evident across the 3143 counties of the United States. We used publicly available county estimates of the age-adjusted prevalence of diagnosed diabetes, obesity, and leisure-time physical inactivity, which were generated by the Centers for Disease Control and Prevention (CDC). Using a Bayesian multilevel regression that included random effects by county and year and applied cubic splines to smooth these estimates over time, we estimated the average annual percentage point change (APPC) from 2004 to 2008 and from 2008 to 2012 for diabetes, obesity, and physical inactivity prevalence in each county. Compared to 2004–2008, the median APPCs for diabetes, obesity, and physical inactivity were lower in 2008–2012 (diabetes APPC difference = 0.16, 95%CI 0.14, 0.18; obesity APPC difference = 0.65, 95%CI 0.59, 0.70; physical inactivity APPC difference = 0.43, 95%CI 0.37, 0.48). APPCs and APPC differences between time periods varied among counties and U.S. regions. Despite improvements, levels of these risk factors remained high with most counties merely slowing rather than reversing, which suggests that all counties would likely benefit from reductions in these risk factors. The diversity of trajectories in the prevalence of these risk factors across counties underscores the continued need to identify high risk areas and populations for preventive interventions. Awareness of how these factors are changing might assist local policy makers in targeting and tracking the impact of efforts to reduce diabetes, obesity and physical inactivity.