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Racial and Ethnic Differences in Obesity in People With Spinal Cord Injury: The Effects of Disadvantaged Neighborhood

Published:March 25, 2019DOI:https://doi.org/10.1016/j.apmr.2019.02.008

      Abstract

      Objective

      To examine the role of neighborhood in the relation between race and obesity in people with spinal cord injury (SCI).

      Design

      A cross-sectional analysis of survey data from National SCI Database linked with neighborhood data from American Community Survey by census tract.

      Setting

      A total of 17 SCI Model Systems centers.

      Participants

      Individuals (N=3385; 2251 non-Hispanic whites, 760 non-Hispanic blacks, 374 Hispanics) who completed a follow-up assessment during 2006-2017 (mean duration of injury, 8.3±9.9y) and resided in 2934 census tracts.

      Intervention

      Not applicable.

      Main Outcome Measures

      Body mass index (BMI) (kg/m2).

      Results

      The overall prevalence of obesity was 52.9% (BMI≥25.0) and 23.3% (BMI≥30.0). Hispanics were 67.0% more likely to be obese (BMI≥30.0 kg/m2) relative to non-Hispanic whites (odds ratio, 1.67; 95% confidence interval, 1.27-2.18), after controlling for demographic and injury-related characteristics. Most of the non-Hispanic blacks (66.8%) were living in neighborhoods with high concentrated disadvantaged index (CDI), compared to 35.0% of Hispanics and 9.2% of non-Hispanic whites living in this similar neighborhood status (P<.0001). After accounting for CDI, the odds of being obese in Hispanics decreased (odds ratio, 1.51; 95% confidence interval, 1.15-1.99). Regardless of race and ethnicity, people with SCI from disadvantaged neighborhoods were 42.0%-70.0% more likely to be obese than those from minimal CDI neighborhoods.

      Conclusions

      Neighborhood characteristics partially diminish racial differences in obesity. Weight management for the SCI population should target those who are Hispanic and living in the disadvantaged neighborhoods.

      Keywords

      List of abbreviations:

      ACS (American Community Survey), AIS (American Spinal Injury Association Impairment Scale), BMI (body mass index), CDI (concentrated disadvantaged index), NSCID (National Spinal Cord Injury Database), SCI (spinal cord injury), SCIMS (Spinal Cord Injury Model System), SES (socioeconomic status)
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      References

        • Flegal K.M.
        • Kruszon-Moran D.
        • Carroll M.D.
        • Fryar C.D.
        • Ogden C.L.
        Trends in obesity among adults in the United States, 2005 to 2014.
        JAMA. 2016; 315: 2284-2291
        • Yarar-Fisher C.
        • Chen Y.
        • Jackson A.B.
        • Hunter G.R.
        Body mass index underestimates adiposity in women with spinal cord injury.
        Obesity. 2013; 21: 1223-1225
        • Spungen A.M.
        • Wang J.
        • Pierson Jr., R.N.
        • Bauman W.A.
        Soft tissue body composition differences in monozygotic twins discordant for spinal cord injury.
        J Appl Physiol. 2000; 88: 1310-1315
        • Weaver F.M.
        • Collins E.G.
        • Kurichi J.
        • et al.
        Prevalence of obesity and high blood pressure in veterans with spinal cord injuries and disorders.
        Am J Phys Med Rehabil. 2007; 86: 22-29
        • Chen Y.
        • Cao Y.
        • Allen V.
        • Richards J.S.
        Weight matters: physical and psychosocial well being of persons with spinal cord injury in relation to body mass index.
        Arch Phys Med Rehabil. 2011; 92: 391-398
        • Afshin A.
        • Forouzanfar M.H.
        • Reitsma M.B.
        • et al.
        • GBD 2015 Obesity Collaborators
        Health effects of overweight and obesity in 195 countries over 25 years.
        N Engl J Med. 2017; 377: 13-27
        • Guh D.P.
        • Zhang W.
        • Bansback N.
        • Amarsi Z.
        • Birmingham C.L.
        • Anis A.H.
        The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis.
        BMC Public Health. 2009; 9: 88
        • Flegal K.M.
        • Kit B.K.
        • Orpana H.
        • Graubard B.I.
        Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis.
        JAMA. 2013; 309: 71-82
        • Tian W.
        • Hsieh C.H.
        • DeJong G.
        • Backus D.
        • Groah S.
        • Ballard P.H.
        Role of body weight in therapy participation and rehabilitation outcomes among individuals with traumatic spinal cord injury.
        Arch Phys Med Rehabil. 2013; 94: S125-S136
        • Stenson K.W.
        • Deutsch A.
        • Heinemann A.W.
        • Chen D.
        Obesity and inpatient rehabilitation outcomes for patients with a traumatic spinal cord injury.
        Arch Phys Med Rehabil. 2011; 92: 384-390
        • Gupta N.
        • White K.T.
        • Sandford P.R.
        Body mass index in spinal cord injury-a retrospective study.
        Spinal Cord. 2006; 44: 92-94
        • Lad S.P.
        • Umeano O.A.
        • Karikari I.O.
        • et al.
        Racial disparities in outcomes after spinal cord injury.
        J Neurotrauma. 2013; 30: 492-497
        • Gary K.W.
        • Nicholls E.
        • Shamburger A.
        • Stevens L.F.
        • Arango-Lasprilla J.C.
        Do racial and ethnic minority patients fare worse after SCI?: a critical review of the literature.
        NeuroRehabilitation. 2011; 29: 275-293
        • Kennedy P.
        • Kilvert A.
        • Hasson L.
        Ethnicity and rehabilitation outcomes: the Needs Assessment Checklist.
        Spinal Cord. 2015; 53: 334-339
        • Fyffe D.C.
        • Deutsch A.
        • Botticello A.L.
        • Kirshblum S.
        • Ottenbacher K.J.
        Racial and ethnic disparities in functioning at discharge and follow-up among patients with motor complete spinal cord injury.
        Arch Phys Med Rehabil. 2014; 95: 2140-2151
        • Mahmoudi E.
        • Meade M.A.
        • Forchheimer M.B.
        • Fyffe D.C.
        • Krause J.S.
        • Tate D.
        Longitudinal analysis of hospitalization after spinal cord injury: variation based on race and ethnicity.
        Arch Phys Med Rehabil. 2014; 95: 2158-2166
        • Krueger P.M.
        • Reither E.N.
        Mind the gap: race/ethnic and socioeconomic disparities in obesity.
        Curr Diab Rep. 2015; 15: 95
        • Krueger P.M.
        • Coleman-Minahan K.
        • Rooks R.N.
        Race/ethnicity, nativity and trends in BMI among U.S. adults.
        Obesity. 2014; 22: 1739-1746
        • WHO
        International Classification of Functioning, Disability and Health (ICF).
        (Available at:)
        http://www.who.int/classifications/icf/en/
        Date accessed: August 22, 2018
        • Botticello A.L.
        • Chen Y.
        • Cao Y.
        • Tulsky D.S.
        Do communities matter after rehabilitation? The effect of socioeconomic and urban stratification on well-being after spinal cord injury.
        Arch Phys Med Rehabil. 2011; 92: 464-471
        • Botticello A.L.
        • Chen Y.
        • Tulsky D.S.
        Geographic variation in participation for physically disabled adults: the contribution of area economic factors to employment after spinal cord injury.
        Soc Sci Med. 2012; 75: 1505-1513
        • Botticello A.L.
        • Rohrbach T.
        • Cobbold N.
        Disability and the built environment: an investigation of community and neighborhood land uses and participation for physically impaired adults.
        Ann Epidemiol. 2014; 24: 545-550
        • Botticello A.L.
        • Boninger M.
        • Charlifue S.
        • et al.
        To what extent do neighborhood differences mediate racial disparities in participation after spinal cord injury?.
        Arch Phys Med Rehabil. 2016; 97: 1735-1744
        • Sampson R.J.
        • Raudenbush S.W.
        • Earls F.
        Neighborhoods and violent crime: a multilevel study of collective efficacy.
        Science. 1997; 277: 918-924
        • PhenX Toolkit
        Protocol overview - neighborhood concentrated disadvantage.
        (Available at:)
        • Hood E.
        Dwelling disparities: how poor housing leads to poor health.
        Environ Health Perspect. 2005; 113: A310-A317
        • Coulon S.J.
        • Velasco-Gonzalez C.
        • Scribner R.
        • et al.
        Racial differences in neighborhood disadvantage, inflammation and metabolic control in black and white pediatric type 1 diabetes patients.
        Pediatr Diabetes. 2017; 18: 120-127
        • Danos D.M.
        • Ferguson T.F.
        • Simonsen N.R.
        • et al.
        Neighborhood disadvantage and racial disparities in colorectal cancer incidence: a population-based study in Louisiana.
        Ann Epidemiol. 2018; 28: 316-321
        • Kepper M.
        • Sothern M.
        • Zabaleta J.
        • et al.
        Prepubertal children exposed to concentrated disadvantage: an exploratory analysis of inflammation and metabolic dysfunction.
        Obesity. 2016; 24: 1148-1153
        • Peterson C.E.
        • Rauscher G.H.
        • Johnson T.P.
        • et al.
        The effect of neighborhood disadvantage on the racial disparity in ovarian cancer-specific survival in a large hospital-based study in Cook County, Illinois.
        Front Public Health. 2015; 3: 8
        • Magasi S.
        • Wong A.
        • Gray D.B.
        • et al.
        Theoretical foundations for the measurement of environmental factors and their impact on participation among people with disabilities.
        Arch Phys Med Rehabil. 2015; 96: 569-577
        • Chen Y.
        • DeVivo M.J.
        • Richards J.S.
        • SanAgustin T.B.
        Spinal Cord Injury Model Systems: review of program and national database from 1970 to 2015.
        Arch Phys Med Rehabil. 2016; 97: 1797-1804
        • U.S. Census Bureau
        A compass for understanding and using American Community Survey data: what general data users need to know.
        (Available at:)
        • United States Census Bureau
        Geography program, glossary - census tract.
        (Available at:) (Accessed April 11, 2019)
        • United States Census Bureau
        Race.
        (Available at:)
        • United States Census Bureau
        Hispanic origin.
        (Available at:)
        • DeVivo M.J.
        • Biering-Sorensen F.
        • New P.
        • Chen Y.
        Standardization of data analysis and reporting of results from the International Spinal Cord Injury Core Data Set.
        Spinal Cord. 2011; 49: 596-599
        • Biering-Sorensen F.
        • DeVivo M.
        • Charlifue S.
        • et al.
        International Spinal Cord Injury Core Data Set (Version 2.0) - including standardization of reporting.
        Spinal Cord. 2017; 55: 759-764
        • U.S. Department of Health and Human Services; National Institutes of Health; National Heart, Lung and Blood Institute
        Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report (NIH Publication No. 98-4083).
        (Available at:)
        • Laughton G.E.
        • Buchholz A.C.
        • Martin Ginis K.A.
        • Goy R.E.
        • SHAPE SCI Research Group
        Lowering body mass index cutoffs better identifies obese persons with spinal cord injury.
        Spinal Cord. 2009; 47: 757-762
        • Wen H.
        • Chen Y.
        • He Y.
        • Bickel C.S.
        • Robinson-Whelen S.
        • Heinemann A.W.
        Racial differences in weight gain: a 5-year longitudinal study of persons with spinal cord injury.
        Arch Phy Med Rehab. 2018; 99: 1957-1964
        • Krishna A.
        • Razak F.
        • Lebel A.
        • Smith G.D.
        • Subramanian S.V.
        Trends in group inequalities and interindividual inequalities in BMI in the United States, 1993-2012.
        Am J Clin Nutr. 2015; 101: 598-605
        • Zea M.C.
        • Quezada T.
        • Belgrave F.Z.
        Latino cultural values: their role in adjustment to disability.
        J Soc Behav Pers. 1994; 9: 185-200
        • Abraido-Lanza A.F.
        • Echeverria S.E.
        • Florez K.R.
        Latino immigrants, acculturation, and health: promising new directions in research.
        Annu Rev Public Health. 2016; 37: 219-236
        • Isasi C.R.
        • Ayala G.X.
        • Sotres-Alvarez D.
        • et al.
        Is acculturation related to obesity in Hispanic/Latino adults? Results from the Hispanic community health study/study of Latinos.
        J Obes. 2015; 2015: 186276
        • Centers of Disease Control & Prevention
        Vital signs: state-specific obesity prevalence among adults—United States, 2009 source.
        MMWR Morb Mortal Wkly Rep. 2010; 59: 951-955
        • Chen Y.
        • He Y.
        • DeVivo M.J.
        Changing demographics and injury profile of new traumatic spinal cord injuries in the United States, 1972-2014.
        Arch Phys Med Rehabil. 2016; 97: 1610-1619
        • Schulz A.J.
        • Mentz G.
        • Lachance L.
        • Johnson J.
        • Gaines C.
        • Israel B.A.
        Associations between socioeconomic status and allostatic load: effects of neighborhood poverty and tests of mediating pathways.
        Am J Public Health. 2012; 102: 1706-1714
        • Iceland J.
        • Wilkes R.
        Does socioeconomic status matter? Race, class, and residential segregation.
        Soc Prob. 2006; 53: 248-273
        • Feng J.
        • Glass T.A.
        • Curriero F.C.
        • Stewart W.F.
        • Schwartz B.S.
        The built environment and obesity: a systematic review of the epidemiologic evidence.
        Health Place. 2010; 16: 175-190
        • Bower K.M.
        • Thorpe Jr., R.J.
        • Rohde C.
        • Gaskin D.J.
        The intersection of neighborhood racial segregation, poverty, and urbanicity and its impact on food store availability in the United States.
        Prev Med. 2014; 58: 33-39
        • Ford E.S.
        • Li C.
        • Wheaton A.G.
        • Chapman D.P.
        • Perry G.S.
        • Croft J.B.
        Sleep duration and body mass index and waist circumference among U.S. adults.
        Obesity. 2014; 22: 598-607
        • Liao Y.
        • Siegel P.Z.
        • Garraza L.G.
        • et al.
        Reduced prevalence of obesity in 14 disadvantaged black communities in the United States: a successful 4-year place-based participatory intervention.
        Am J Public Health. 2016; 106: 1442-1448
        • Connor Gorber S.
        • Tremblay M.
        • Moher D.
        • Gorber B.
        A comparison of direct vs. self-report measures for assessing height, weight and body mass index: a systematic review.
        Obes Rev. 2007; 8: 307-326