Differences in Obesity Prevalence by Demographic Characteristics and Urbanization Level Among Adults in the United States, 2013-2016
Differences in Obesity Prevalence by Demographic Characteristics and Urbanization Level Among Adults in the United States, 2013-2016
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DOI：
10.1001/jama.2018.7270
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发表时间：
2018-06-19
影响因子：
120.7
通讯作者：
Ogden, Cynthia L.
中科院分区：
文献类型：
--
作者：
Hales, Craig M.;Fryar, Cheryl D.;Ogden, Cynthia L.
重要性 美国成年人中按性别、年龄组、种族和西班牙裔血统划分的肥胖差异已有报道，但按城市化水平划分的差异研究较少。 目的 根据人口特征和城市化水平提供对肥胖的估计，并按城市化水平检查肥胖患病率的趋势。 设计、环境和参与者 对 2001-2016 年国家健康和营养检查中 20 岁或以上成年人测量的身高和体重进行系列横断面分析调查，对平民、非机构化美国人口进行的全国代表性调查。 暴露 按大都市统计区（MSA；大型：> 100 万人口）评估的性别、年龄组、种族和西班牙裔血统、教育水平、吸烟状况和城市化水平。 主要结果和措施 各亚组的肥胖率（体重指数 [BMI] > 30）和严重肥胖症（BMI > 40） 2013-2016 年以及 2001-2004 年和 2013-2016 年按城市化水平划分的趋势。 结果 提供了 10 792 名成年人（平均年龄 48 岁；51% 女性[加权]）的体重、身高和城市化水平的完整数据。 2013-2016年期间，38.9%（95% CI，37.0%至40.7%）的美国成年人患有肥胖症，7.6%（95% CI，6.8%至8.6%）患有严重肥胖。与生活在大型 MSA 中的男性相比，生活在中型或小型 MSA 中的男性的肥胖患病率更高（分别为 42.4% 和 31.8%；调整后差异，9.8 个百分点 [95% CI，5.1 至 14.5 个百分点]）；然而，生活在非 MSA 的男性与生活在大型 MSA 的男性相比，年龄调整患病率没有显着差异（分别为 38.9% 和 31.8%；调整后差异，4.8 个百分点 [95% CI，-2.9 至 12.6 个百分点]）。与居住在大型MSA的女性相比，居住在中型或小型MSA的女性的肥胖患病率较高（分别为42.5% vs 38.1%；调整后的差异，4.3个百分点[95% CI，0.2至8.5个百分点]），生活在非MSA的女性与居住在大型MSA的女性相比（分别为47.2% vs 38.1%；调整后的差异，4.7个百分点[95%]）。 CI，0.2 至 9.3 个百分点]）。严重肥胖也有类似的模式，只是生活在大型 MSA 的男性与非 MSA 的男性之间存在显着差异。肥胖和严重肥胖的年龄调整患病率也因年龄组、种族和西班牙裔血统以及教育水平而存在显着差异，并且这些变化模式通常因性别而异。 2001-2004年和2013-2016年间，所有城市化水平的所有成年人中，年龄调整后的肥胖和严重肥胖患病率均显着增加。结论和相关性在这项对美国成年人进行的全国代表性调查中，2013-2016年年龄调整后的肥胖和严重肥胖患病率因城市化水平而异，生活在非大都市统计区域的成年人中肥胖和严重肥胖的患病率显着更高与生活在大都市统计区的成年人相比。
IMPORTANCE Differences in obesity by sex, age group, race and Hispanic origin among US adults have been reported, but differences by urbanization level have been less studied.OBJECTIVES To provide estimates of obesity by demographic characteristics and urbanization level and to examine trends in obesity prevalence by urbanization level.DESIGN, SETTING, AND PARTICIPANTS Serial cross-sectional analysis of measured height and weight among adults aged 20 years or older in the 2001-2016 National Health and Nutrition Examination Survey, a nationally representative survey of the civilian, noninstitutionalized US population.EXPOSURES Sex, age group, race and Hispanic origin, education level, smoking status, and urbanization level as assessed by metropolitan statistical areas (MSAs; large: > 1 million population).MAIN OUTCOMES AND MEASURES Prevalence of obesity (body mass index [BMI] > 30) and severe obesity (BMI > 40) by subgroups in 2013-2016 and trends by urbanization level between 2001-2004 and 2013-2016.RESULTS Complete data on weight, height, and urbanization level were available for 10 792 adults (mean age, 48 years; 51% female [weighted]). During 2013-2016, 38.9% (95% CI, 37.0% to 40.7%) of US adults had obesity and 7.6%(95% CI, 6.8% to 8.6%) had severe obesity. Men living in medium or small MSAs had a higher age-adjusted prevalence of obesity compared with men living in large MSAs (42.4% vs 31.8%, respectively; adjusted difference, 9.8 percentage points [95% CI, 5.1 to 14.5 percentage points]); however, the age-adjusted prevalence among men living in non-MSAs was not significantly different compared with men living in large MSAs (38.9% vs 31.8%, respectively; adjusted difference, 4.8 percentage points [95% CI, -2.9 to 12.6 percentage points]). The age-adjusted prevalence of obesity was higher among women living in medium or small MSAs compared with women living in large MSAs (42.5% vs 38.1%, respectively; adjusted difference, 4.3 percentage points [95% CI, 0.2 to 8.5 percentage points]) and among women living in non-MSAs compared with women living in large MSAs (47.2% vs 38.1%, respectively; adjusted difference, 4.7 percentage points [95% CI, 0.2 to 9.3 percentage points]). Similar patterns were seen for severe obesity except that the difference between men living in large MSAs compared with non-MSAs was significant. The age-adjusted prevalence of obesity and severe obesity also varied significantly by age group, race and Hispanic origin, and education level, and these patterns of variation were often different by sex. Between 2001-2004 and 2013-2016, the age-adjusted prevalence of obesity and severe obesity significantly increased among all adults at all urbanization levels.CONCLUSIONS AND RELEVANCE In this nationally representative survey of adults in the United States, the age-adjusted prevalence of obesity and severe obesity in 2013-2016 varied by level of urbanization, with significantly greater prevalence of obesity and severe obesity among adults living in nonmetropolitan statistical areas compared with adults living in large metropolitan statistical areas.