背景:居住在弱势社区与死亡率增加有关。然而,居住隔离和社会脆弱性对特定原因死亡率的影响研究不足。此外,社区社会人口统计学环境的循环代谢相关性仍未被探索。因此,我们检查了多个邻域社会人口统计学指标,即,邻域剥夺指数(NDI),住宅隔离指数(RSI),和社会脆弱性指数(SVI),南方社区队列研究(SCCS)中的全因和心血管疾病(CVD)以及癌症特异性死亡率和循环代谢产物。
方法:SCCS是一个前瞻性队列,主要是40-79岁的低收入成年人,在2002-2009年期间从美国东南部注册。该分析包括自我报告的黑人/非裔美国人或非西班牙裔白人参与者,并排除了那些死亡或失去随访≤1年的参与者。使用SCCS参与者子集的基线血浆样品进行非靶向代谢物分析。
结果:在79,631名参与者中,在中位15年的随访中,记录了23,356例死亡(7214例CVD和5394例癌症)。更高的NDI,RSI,SVI与全因增加有关,CVD,和癌症死亡率,独立于标准的临床和社会人口统计学危险因素,并且在种族组之间是一致的(在年龄/性别/种族校正模型中,所有参与者的标准化HR为1.07~1.20,在综合校正后为1.04~1.08;除癌症死亡率外,所有P<0.05/3).标准危险因素解释了<40%的NDI/RSI/SVI变化,并介导了<70%的它们与死亡率的关联。在1688名参与者中测量的1110种循环代谢物中,134和27个代谢物与NDI和RSI相关(所有FDR<0.05),并介导了NDI/RSI死亡率关联的61.7%和21.2%,分别。将这些代谢物添加到标准危险因素中,NDI/RSI死亡率关联的调解比例从38.4增加到87.9%,从25.8增加到42.6%,分别。
结论:在生活在美国东南部的低收入黑人/非裔美国成年人和非西班牙裔白人成年人中,社区不利的社会人口统计学环境与超过标准危险因素的全因死亡率和CVD死亡率以及癌症特异性死亡率增加相关.循环代谢物可能揭示了社区社会人口统计学环境对健康影响的生物学途径。更多的公共卫生工作应该致力于减少邻里环境相关的健康差距,尤其是低收入人群。
BACKGROUND: Residing in a disadvantaged neighborhood has been linked to increased mortality. However, the impact of residential segregation and social vulnerability on cause-specific mortality is understudied. Additionally, the circulating metabolic correlates of neighborhood sociodemographic environment remain unexplored. Therefore, we examined multiple neighborhood sociodemographic metrics, i.e., neighborhood deprivation index (NDI), residential segregation index (RSI), and social vulnerability index (SVI), with all-cause and cardiovascular disease (CVD) and cancer-specific mortality and circulating metabolites in the Southern Community Cohort Study (SCCS).
METHODS: The SCCS is a prospective cohort of primarily low-income adults aged 40-79, enrolled from the southeastern United States during 2002-2009. This analysis included self-reported Black/African American or non-Hispanic White participants and excluded those who died or were lost to follow-up ≤ 1 year. Untargeted metabolite profiling was performed using baseline plasma samples in a subset of SCCS participants.
RESULTS: Among 79,631 participants, 23,356 deaths (7214 from CVD and 5394 from cancer) were documented over a median 15-year follow-up. Higher NDI, RSI, and SVI were associated with increased all-cause, CVD, and cancer mortality, independent of standard clinical and sociodemographic risk factors and consistent between racial groups (standardized HRs among all participants were 1.07 to 1.20 in age/sex/race-adjusted model and 1.04 to 1.08 after comprehensive adjustment; all P < 0.05/3 except for cancer mortality after comprehensive adjustment). The standard risk factors explained < 40% of the variations in NDI/RSI/SVI and mediated < 70% of their associations with mortality. Among 1110 circulating metabolites measured in 1688 participants, 134 and 27 metabolites were associated with NDI and RSI (all FDR < 0.05) and mediated 61.7% and 21.2% of the NDI/RSI-mortality association, respectively. Adding those metabolites to standard risk factors increased the mediation proportion from 38.4 to 87.9% and 25.8 to 42.6% for the NDI/RSI-mortality association, respectively.
CONCLUSIONS: Among low-income Black/African American adults and non-Hispanic White adults living in the southeastern United States, a disadvantaged neighborhood sociodemographic environment was associated with increased all-cause and CVD and cancer-specific mortality beyond standard risk factors. Circulating metabolites may unveil biological pathways underlying the health effect of neighborhood sociodemographic environment. More public health efforts should be devoted to reducing neighborhood environment-related health disparities, especially for low-income individuals.