美国退伍军人事务部Mark D. Schwartz团队研究了失控慢性病患病率的地理差异与个体患失控慢性病概率变化的相关性。2020年10月13日，该研究发表在《美国医学会杂志》上。

美国发病和死亡的主要危险因素在各个地区、州和社区之间的流行程度存在显著差异，但这些差异与个人居住地的相关程度以及在不同地区生活的人的特征尚不清楚。

为了通过比较搬到不同地区或没有搬家的个人的健康结局趋势，来估计主要危险因素的地理差异与居住地点的关联程度，研究组进行了一项回顾性队列研究，估计了搬家者的目的地和出发地之间失控慢性病患病率的差异，以及个人在搬家后患失控慢性病的概率相关性。

研究组使用退伍军人健康管理局的电子健康记录，初步分析包括5342207名退伍军人，他们在2008-2018年邮政编码改过一次或从未更改。主要结局为搬家的前3年和后3年，每季度中血压失控（收缩压>140 mmHg或舒张压>90 mmHg）、糖尿病失控（血红蛋白A1c水平>8%）、肥胖（体重指数>30）和抑郁症（2项患者健康问卷得分≥2分）的患病率。

5342207名患者的平均年龄为57.6岁，男性占93.0%，白人占72.5%，黑人占12.7%，其中1095608名搬家过一次，4246599名从未搬过家。在搬家人口中，血压失控率在不同地区间的差异为27.5%，糖尿病失控率为5.0%，肥胖率为3.1%，抑郁症患病率为15.2%。

研究组表明，退伍军人搬家后，地理差异导致血压失控和抑郁症的发生率显著增高，但糖尿病失控和肥胖的发生率变化较小。

附：英文原文

Title: Association of Geographic Differences in Prevalence of Uncontrolled Chronic Conditions With Changes in Individuals’ Likelihood of Uncontrolled Chronic Conditions

Author: Aaron Baum, Juan Wisnivesky, Sanjay Basu, Albert L. Siu, Mark D. Schwartz

Issue&Volume: 2020/10/13

Abstract:

Importance  The prevalence of leading risk factors for morbidity and mortality in the US significantly varies across regions, states, and neighborhoods, but the extent these differences are associated with a person’s place of residence vs the characteristics of the people who live in different places remains unclear.

Objective  To estimate the degree to which geographic differences in leading risk factors are associated with a person’s place of residence by comparing trends in health outcomes among individuals who moved to different areas or did not move.

Design, Setting, and Participants  This retrospective cohort study estimated the association between the differences in the prevalence of uncontrolled chronic conditions across movers’ destination and origin zip codes and changes in individuals’ likelihood of uncontrolled chronic conditions after moving, adjusting for person-specific fixed effects, the duration of time since the move, and secular trends among movers and those who did not move. Electronic health records from the Veterans Health Administration were analyzed. The primary analysis included 5342207 individuals with at least 1 Veterans Health Administration outpatient encounter between 2008 and 2018 who moved zip codes exactly once or never moved.

Exposures  The difference in the prevalence of uncontrolled chronic conditions between a person’s origin zip code and destination zip code (excluding the individual mover’s outcomes).

Main Outcomes and Measures  Prevalence of uncontrolled blood pressure (systolic blood pressure level >140 mm Hg or diastolic blood pressure level >90 mm Hg), uncontrolled diabetes (hemoglobin A1c level >8%), obesity (body mass index >30), and depressive symptoms (2-item Patient Health Questionnaire score ≥2) per quarter-year during the 3 years before and the 3 years after individuals moved.

Results  The study population included 5342207 individuals (mean age, 57.6 [SD, 17.4] years, 93.9% men, 72.5% White individuals, and 12.7% Black individuals), of whom 1095608 moved exactly once and 4246599 never moved during the study period. Among the movers, the change after moving in the prevalence of uncontrolled blood pressure was 27.5% (95% CI, 23.8%-31.3%) of the between-area difference in the prevalence of uncontrolled blood pressure. Similarly, the change after moving in the prevalence of uncontrolled diabetes was 5.0% (95% CI, 2.7%-7.2%) of the between-area difference in the prevalence of uncontrolled diabetes; the change after moving in the prevalence of obesity was 3.1% (95% CI, 2.0%-4.2%) of the between-area difference in the prevalence of obesity; and the change after moving in the prevalence of depressive symptoms was 15.2% (95% CI, 13.1%-17.2%) of the between-area difference in the prevalence of depressive symptoms.

Conclusions and Relevance  In this retrospective cohort study of individuals receiving care at Veterans Health Administration facilities, geographic differences in prevalence were associated with a substantial percentage of the change in individuals’ likelihood of poor blood pressure control or depressive symptoms, and a smaller percentage of the change in individuals’ likelihood of poor diabetes control and obesity. Further research is needed to understand the source of these associations with a person’s place of residence.

DOI: 10.1001/jama.2020.14381

Source: https://jamanetwork.com/journals/jama/article-abstract/2771607