Racial/Ethnic Differences in Obesity in Individuals with Spinal Cord Injury: The Impact of Disadvantaged Neighborhood
1Wen H, 1Chen Y, 2Botticello A, 1Bae S
1University of Alabama at Birmingham, Birmingham, Alabama, United states; 2 Kessler Foundation, West Orange, new jerse, US
Objective: To examine the role of neighborhood in the relationship between race and obesity in people with spinal cord injury (SCI).
Design/Methods: This is a cross-sectional study of the survey data from 16 SCI model systems linked with neighborhood data from the US census. 3,129 individuals (2,101 non-Hispanic whites, 693 non-Hispanic blacks and 335 Hispanics) who incurred SCI 1973 to 2015 and completed a follow-up assessment between 2006 and 2016 were from 2,739 census tracts. Logistic regression was used to estimate the odds ratio (OR) of being obese (body mass index ≥ 30 kg/m2) in non-Hispanic blacks and Hispanics as compared to non-Hispanic whites (model 1). Model 2 estimated the OR by racial groups after controlling for demographic factors (current age, gender, marital status, education and occupation). Model 3 estimated the OR by extending model 2 with injury-related factors (etiology, neurological status, and years since injury). Model 4 included model 3 variables and concentrated disadvantaged index (CDI) groups. Interaction between race and neighborhood was also examined.
Results: of 3,129 participants, 23.3 % were obese. Hispanics had the greatest obesity prevalence (30.5%, n=102), followed by non-Hispanic blacks (23.5%, n=163) and non-Hispanic whites (22.0%, n=463; p=.003). In unadjusted analysis, Hispanics were 54.9% more likely to be obese relative to non-Hispanic whites (Model; OR,1.55; 95% CI, 1.2-2.0). Neighborhood (Model 4; OR, 1.47; 95% CI, 1.10-1.98) mitigated the intensify effect of demographic (Model 2; OR, 1.71; 95% CI, 1.30-2.24) and injury-related factors (Model 3; OR, 1.64; 95% CI, 1.23-2.20) on difference in obesity prevalence between Hispanics and Non-Hispanic whites. Although non-Hispanic blacks lived in the high disadvantaged neighborhood (High disadvantaged, 0.5 < CDI < 5.5), no significant difference was noted in obesity prevalence between non-Hispanic blacks and non-Hispanic whites. Regardless of racial groups, the odds of being obese for people with SCI from the high disadvantaged neighborhood was nearly twice than those from the minimal disadvantaged neighborhood (High vs Minimal, OR=1.9, 95% CI, 1.4-2.5). The interaction term in logistic regression model was not significant (p=0.282).
Conclusion: Unlike the pattern of racial differences in obesity in the general population, Hispanics are more likely to be obese than other racial groups in the SCI population. To address the disadvantaged in the neighborhood level could mitigate the difference in obesity between Hispanics and non-Hispanic whites. Environmental researches will help us to understand the relationship between race and obesity in the SCI population.
Support: This work is supported by funding from the National Institute on Disability, Independent Living, and Rehabilitation Research (#90DP0083) and National Institute of Minority Health and Health Disparities (U54MD008176).
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