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目的考察社区城镇化水平与成人超重发生风险关系的时期和地区差异。方法采用分层多阶段整群随机抽样方法,选择1991—2015年"中国健康与营养调查"中来自沿海、中部、东北和西部地区的九省(自治区)的8684位20～64岁成人为研究对象,通过城镇化指数测量社区城镇化水平,并将社区划分为高城镇化水平和低城镇化水平社区。采用分层Logistic回归模型考察城镇化水平与超重发生关系的时期和地区差异。结果 38.08%的受访者在随访过程中发生超重。高城镇化水平与沿海(OR=0.45,95%CI 0.34～0.60)、中部(OR=0.67,95%CI 0.52～0.86)、东北(OR=0.70,95%CI 0.52～0.94)的交互项有统计学意义。高城镇化水平与时期的交互项也有统计学意义(OR=0.97,95%CI 0.96～0.99)。在1991年时,除沿海地区外(OR=0.99,95%CI 0.77～1.26),高城镇化水平与超重发生在中部(OR=1.45,95%CI 1.15～1.83)、东北(OR=1.53,95%CI 1.16～2.02)和西部(OR=2.18,95%CI 1.68～2.83)呈正相关且有统计学意义。在2015年时,高城镇化水平与超重发生在沿海(OR=0.53,95%CI 0.41～0.68)和中部(OR=0.77,95%CI 0.62～0.97)呈负相关且有统计学意义;在东北(OR=0.82,95%CI 0.63～1.05)和西部地区(OR=1.17,95%CI 0.91～1.49)的关系无统计学意义。结论在中国九省(自治区)成人中,社区城镇化水平与成人超重发生风险的关系因时、因地而异。
Abstract：OBJECTIVE To explore whether the association of community urbanization levels with overweight incidence changes over time and varies by region. METHODS The data is from the China Health and Nutrition Survey(1991-2015). The survey applied a multistage, random cluster design to draw samples. A total of 8684 adults aged 20-64 years were confined in nine provinces(autonomous regions). Based on an urbanicity score, communities were divided into two groups: low-and high-urbanization-level groups. The nine provinces(autonomous regions) were divided into four regions, including the Coast, Central, Northeast and West. Multilevel Logistic regression models was applied to examine whether the association between urbanization levels and overweight incidence changed over time and varied by region. RESULTS 38.08% of respondents became overweight during the follow-up surveys.The interactions between the high urbanization level with the Coast(OR=0.45, 95%CI 0.34-0.60), the Central(OR=0.67, 95%CI 0.52-0.86), and the Northeast(OR=0.70, 95%CI 0.52-0.94) were statistically significant. The interaction between the high urbanization level and period was also statistically significant(OR=0.97, 95%CI 0.96-0.99). In 1991, the Coast(OR=0.99, 95%CI 0.77-1.26), the high urbanization level was positively associated with overweight incidence in the Central(OR=1.45, 95%CI 1.15-1.83), Northeast(OR=1.53, 95%CI 1.16-2.02) and West(OR=2.18, 95%CI 1.68-2.83), with statistical significance. In 2015, the high urbanization level was significantly negatively associated with overweight incidence in the Coast(OR=0.53, 95%CI 0.41-0.68) and Central(OR=0.77, 95%CI 0.62-0.97), while the association in the Northeast(OR=0.82, 95%CI 0.63-1.05) and West(OR=1.17, 95%CI 0.91-1.49) was statistically insignificant. CONCLUSION There were spatiotemporal variations in the association between urbanization levels and overweight incidence among adults in the nine provinces(autonomous regions).
[1] ZHOU M,WANG H,ZENG X,et al.Mortality,morbidity,and risk factors in China and its provinces,1990-2017:a systematic analysis for the Global Burden of Disease Study 2017[J].Lancet,2019,394(10204):1145-1158.
[2] KIM S,SYMONS M,POPKIN B M.Contrasting socioeconomic profiles related to healthier lifestyles in China and the United States[J].Am J Epidemiol,2004,159(2):184-191.
[3] GU D,REYNOLDS K,WU X,et al.Prevalence of the metabolic syndrome and overweight among adults in China[J].Lancet,2005,365(9468):1398-1405.
[4] ALLENDER S,LACEY B,WEBSTER P,et al.Level of urbanization and noncommunicable disease risk factors in Tamil Nadu,India[J].Bull World Health Organ,2010,88:297-304.
[5] CHOW C K,TEO K K,RANGARAJAN S,et al.Prevalence,awareness,treatment,and control of hypertension in rural and urban communities in high-,middle-,and low-income countries[J].JAMA,2013,310(9):959-968.
[6] POPKIN B M.Urbanization,lifestyle changes and the nutrition transition[J].World Dev,1999,27(11):1905-1916.
[7] GONG P,LIANG S,CARLTON E J,et al.Urbanisation and health in China[J].Lancet,2012,379(9818):843-852.
[8] NCD Risk Factor Collaboration.Rising rural body-mass index is the main driver of the global obesity epidemic in adults[J].Nature,2019,569(7755):260.
[9] BEFORT C A,NAZIR N,PERRI M G.Prevalence of obesity among adults from rural and urban areas of the United States:findings from NHANES (2005-2008)[J].J Rural Health,2012,28(4):392-397.
[10] MARQUES A,PERALTA M,NAIA A,et al.Prevalence of adult overweight and obesity in 20 European countries,2014[J].Eur J Public Health,2018,28(2):295-300.
[11] WEN M,FAN J X,KOWALESKI-JONES L,et al.Rural-urban disparities in obesity prevalence among working age adults in the United States:exploring the mechanisms[J].Am J Health Promot,2018,32(2):400-408.
[12] POPKIN B M,DU S,ZHAI F,et al.Cohort profile:the China Health and Nutrition Survey:monitoring and understanding socio-economic and health change in China,1989-2011[J].Int J Epidemiol,2009,39(6):1435-1440.
[13] 中国肥胖问题工作组.中国成人超重和肥胖症预防与控制指南(节录)[J].营养学报，2004,26 (1):1-4.
[14] JONES-SMITH J C,POPKIN B M.Understanding community context and adult health changes in China:development of an urbanicity scale[J].Soc Sci Med,2010,71(8):1436-1446.
[15] 中华人民共和国国家统计局.东西中部和东北地区划分方法[EB/OL].[2020-04-24].http://www.stats.gov.cn/ztjc/zthd/sjtjr/dejtjkfr/tjkp/201106/t20110613_71947.htm.
[16] POPKIN B M.Nutritional patterns and transitions[J].Popul Dev Rev,1993:138-157.
[17] INOUE Y,HOWARD A G,THOMPSON A L,et al.Secular change in the association between urbanisation and abdominal adiposity in China (1993-2011)[J].J Epidemiol Community Health,2018,72(6):484-490.
[18] ZHANG N.Urban-rural disparities in cardiovascular disease risks among middle-aged and older Chinese:two decades of urbanisation[J].Ageing Soc,2019:1-23.
[19] LONG H,ZOU J,PYKETT J,LI Y.Analysis of rural transformation development in China since the turn of the new millennium[J].Appl Geogr,2011,31(3):1094-1105.
[20] ZHAI F Y,DU S F,WANG Z H,et al.Dynamics of the Chinese diet and the role of urbanicity,1991-2011[J].OBES REV,2014,15:16-26.
[21] ATTARD S M,HOWARD A G,HERRING A H,et al.Differential associations of urbanicity and income with physical activity in adults in urbanizing China:findings from the population-based China Health and Nutrition Survey 1991-2009[J].Int J Behav Nutr Phy,2015,12(1):152.
[22] DONG Y,MA Y,DONG B,et al.Geographical variation and urban-rural disparity of overweight and obesity in Chinese school-aged children between 2010 and 2014:two successive national cross-sectional surveys[J].BMJ Open,2019,9(4):e025559.
[23] SENGUPTA A,ANGELI F,SYAMALA TS,et al.Overweight and obesity prevalence among Indian women by place of residence and socio-economic status:contrasting patterns from ‘underweight states’ and ‘overweight states’ of India[J].Soc Sci Med,2015,138:161-169.
[24] ZHUO Q,WANG Z,PIAO J,et al.Geographic variation in the prevalence of overweight and economic status in Chinese adults[J].Brit J Nutr,2009,102(3):413-418.
[25] BAKER D P,SMITH W C,MUNOZ I G,et al.The population education transition curve:education gradients across population exposure to new health risks[J].Demography,2017,54(5):1873-1895.
基本信息:
DOI：10.19813/j.cnki.weishengyanjiu.2021.05.005
中图分类号:R589.2
引用信息:
[1]吴金晶,陈佳,李贞.1991—2015年中国九省社区城镇化水平与成人超重发生风险关系的时空演变[J].卫生研究,2021,50(05):728-734.DOI:10.19813/j.cnki.weishengyanjiu.2021.05.005.
基金信息:
上海市社科规划青年项目(No.2020ESH003)
2021-09-18
2021-09-18