标题：Gender-Specific Associations of Objective and Perceived Neighborhood Characteristics With Body Mass Index and Waist Circumference Among Older Adults in the English Longitudinal Study of Ageing
摘要：Objectives. We sought to determine whether objective and perceived neighborhood characteristics are independently associated with obesity indicators among older adults and whether associations differ by gender. Methods. Linear regression was used to examine mutually adjusted associations of objective area-level neighborhood deprivation and perceived individual-level neighborhood disorder in 2002–2003 with body mass index (BMI) and waist circumference (WC) 2 years later among 6297 community-dwelling older adults in the English Longitudinal Study of Ageing. Results. Associations between neighborhood characteristics and obesity indicators were evident for women only. Being in the most deprived quintile of neighborhood deprivation was associated with a BMI that was 1.18 kilograms per meters squared higher (95% confidence interval [CI] = 0.54, 1.83) and a WC that was 2.42 centimeters higher (95% CI = 0.90, 3.94) at follow-up in women after adjustment for baseline health status, socioeconomic factors, and neighborhood disorder. Neighborhood disorder was not independently associated with BMI or WC. Conclusions. Among women, greater objective neighborhood deprivation was independently associated with higher BMI and WC after 2 years. Public efforts to reduce obesity among community-dwelling older women may benefit most from addressing objective residential characteristics, over and above subjective perceptions. Obesity increases the risk of heart disease, type 2 diabetes, stroke, and some types of cancer, 1 making it an important condition to prevent and manage for any population. According to 2012 estimates, one third of men and women in England between 65 and 74 years of age are considered obese, the highest percentages of any age group. 2 Although in general, levels of obesity (as measured via body mass index [BMI]) decrease after the age of 75 years, levels of abdominal adiposity (as measured via waist circumference [WC]) continue to increase with advancing age, particularly among women. 2 With a 39% increase among individuals aged 65 to 84 years and a 106% increase among those older than 85 years expected from 2012 to 2032 in England alone, 3,4 it is increasingly important to build a broader understanding of obesity risk at older ages. Obesity may be best understood within the context of its wider environmental influences. 5 Older adults may restrict much of their daily life activity to their residential environment, as a result of either retirement or functional limitations, and may consequently be more influenced by these surroundings than younger adults. 6 Thus, examining aspects of neighborhood environments may increase our understanding of obesity risk among older adults in particular. Although definitions vary, a neighborhood is broadly regarded as the area immediately surrounding one’s place of residence, measured either objectively at the area level through census data or predefined boundaries, or subjectively at the individual level through self-reported perceptions. 7 Objective neighborhood characteristics associated with an individual’s obesity risk include residential density, walkability, presence of graffiti, local access to recreational facilities, presence of green space and supermarkets, and inadequate housing; unfavorable levels of these characteristics may together form a concept known as “neighborhood deprivation.” 8,9 Associations between objective neighborhood factors and obesity risk have been shown to be gender-specific. For instance, one study showed that women living in the most deprived areas of the United Kingdom had a higher baseline BMI than those living in the least deprived areas and exhibited greater BMI increases over 13 years, 10 whereas these associations were not evident among men. By contrast, subjective neighborhood characteristics may include individual perceptions of built attributes, interpersonal relationships, or safety. A subjective general construct known as “neighborhood disorder” aims to capture perceptions of both physical and social factors by incorporating dimensions such as safety, trust of neighbors, vandalism, and area cleanliness 11 ; thus, this construct may include neighborhood characteristics that are particularly salient for the individual. Greater neighborhood disorder has been associated with higher levels of obesity indicators such as waist-to-hip ratio 11 and BMI. 12 Despite the fact that both area-level objective and individual-level perceived aspects of neighborhoods demonstrate associations with obesity risk, the independence of these associations is unknown. Furthermore, their relevance to older populations and their gender-specific nature have not been established. Evidence also suggests that effects on obesity indicators may differ. For instance, objective neighborhood deprivation has been associated with higher BMI, 10 whereas subjective neighborhood disorder has been associated with both higher BMI 12 and higher central adiposity. 11 It would be useful to examine effects of neighborhood measures on separate indicators of obesity to understand which aspects are most strongly associated with obesity risk and, thus, the areas in which efforts to intervene would be best directed. In this study, involving a large sample of community-dwelling older adults in England, we sought to determine whether area-level objective neighborhood characteristics and individual-level subjective perceptions of the neighborhood environment are associated with obesity indicators independently of one another and whether these associations are gender-specific.
