Regional dietary patterns and regional disparities in mortality in the US populat

描述(由申请人提供)：在过去的几十年里，美国人口的预期寿命有了相当大的提高，但预期寿命的地理差异持续存在，甚至扩大了。疾病和死亡率区域差异的根本原因是多方面和复杂的。大量的证据已经证实了饮食在预防和管理慢性病中的作用；因此，可以合理地假设饮食可能是 健康。然而，在已发表的文献中，很少有关于饮食属性的地理差异或饮食地区差异对美国人口健康结果的地区差异的可能贡献的信息。了解饮食属性的区域差异与死亡率区域差异的关系，可以告诉我们不同的区域健康结果是通过哪些途径表现出来并可能得到改善的。为了填补这些空白，我们建议使用过去20年(1988-2010年)收集的具有全国代表性的饮食和死亡率数据来检验两个相关的假设。第一个假设测试了国家地区与饮食属性、模式和生物标记物的独立关联。这一假设的具体目的是检查第三次全国健康和营养检查调查(NHANES III，1988-1994)和NHANES 1999-2010的地理编码数据，以确定美国成年人(n&gt；40,000)的饮食模式和营养生物标记物是否因国家的地区而不同，以及这种关联20年来长期趋势的性质。第二个假设考察了饮食模式和饮食生物标记物的地区差异是否与基线年龄为40岁的美国人在平均10年的随访后预期死亡风险的地区差异有关。第二个假设的具体目的是检查NHANES III(1988-1994)和NHANES 1999-2004(n&gt；17,000；&gt；4600推定死亡)中具有全国代表性的地理编码个人水平饮食和死亡率数据，以确定在对个人和邻居特征进行调整后，全因和特定原因死亡率的区域差异程度。我们将使用固定效应多元线性回归和Cox比例风险回归模型，以及适用于复杂调查数据的具有分层随机效应的多水平回归模型来检验饮食因素的相关性及其与地理特征的交互作用。

DESCRIPTION (provided by applicant): Considerable gains in life expectancy in the US population have occurred over the past several decades, yet geographic differences in life expectancy have persisted or even increased. The underlying causes of these regional gradients in disease and mortality rates are multiple and complex. A sizable body of evidence has established the role of diet in both prevention and management of chronic diseases; therefore, it is reasonable to posit that diet may be a mediating factor in regional disparities in health. Yet, there is little information in the published literature on geographic variation in dieary attributes or the possible contribution of regional differentials in diet to regional disparities i health outcomes in the US population. An understanding of regional differences in dietary attributes in relation to regional differentials in mortality informs us about pathways through which disparate regional health outcomes are manifested and may be ameliorated. To fill these gaps, we propose to use nationally representative dietary and mortality data collected over the past 20 years (1988- 2010) to examine two related hypotheses. The first hypothesis tests the independent association of region of the country with dietary attributes, patterns, and biomarkers. The specific aims of this hypothesis are to examine geocoded data from the third National Health and Nutrition Examination survey (NHANES III, 1988- 1994) and the NHANES 1999-2010 to determine whether dietary patterns and nutritional biomarkers of American adults (n> 40,000) differ by region of the country, and the nature of 20-year secular trends in this association. The second hypothesis examines whether regional differences in diet patterns and dietary biomarkers are related to regional differences in the prospective risk of mortality after a average of 10 years of follow-up in Americans aged >40 years at baseline. The specific aims of the second hypothesis are to examine nationally representative geocoded individual-level diet and mortality data from the NHANES III (1988-1994) and the NHANES 1999-2004 (n>17,000; >4600 presumed deceased) to determine the extent of regional differences in all-cause and cause-specific mortality that are attributable to regional differences in dietary patterns after adjustment for individual and neighborhood characteristics. We will use fixed effects multiple linear regression and Cox proportional hazards regression models, and multilevel regression modeling with hierarchical random effects suitable for complex survey data to examine associations of dietary factors and their interactions with geographical characteristics.