Neighborhood Characteristics and Hypertension
Although living in socioeconomically disadvantaged neighborhoods is associated with greater cardiovascular disease (CVD), the relationship between CVD risk and neighborhood constructs is poorly understood. Clouding the understanding of these relationships is that socioeconomic neighborhood position has been used as the neighborhood-level variable investigated, a practice that does not allow for investigation of specific causal processes linking neighborhood environments and CVD risk.
The authors used data collected between 2000–2002 from the Multi-ethnic Study of Atherosclerosis. Their cross-sectional analysis included data from 2,612 adults aged 45–85 years old. Hypertension was defined as systolic pressure above 140 mm Hg, diastolic above 90 mm Hg, or use of antihypertensive medication. Information about 495 neighborhoods was gathered using a telephone survey to rate conditions such as walkability, availability of healthy foods, safety and social cohesion.
Results indicated that individuals in neighborhoods with better walkability, more healthy food available and more social cohesion have a lower risk of having CVD. These associations persisted after adjustment for socioeconomic indicators, but were attenuated after adjustment for race/ethnicity. The authors hypothesize that possible mechanisms to explain the lower CVD risk associated with certain neighborhood characteristics are through effects on diet and activity. Psychosocial stress associated with poor neighborhood safety and lower social cohesion may also be factors in increased CVD risk.
Limitations of this study include use of census tracts as proxies for neighborhoods, and the cross-sectional design. Hypertension is cumulative: therefore, a history of exposure to risk factors may be more important than point-in-time exposures. In this study, however, 46 percent of participants had resided in the same neighborhood for at least 20 years, and most participants reported spending, on average, 75 percent of their time in their neighborhood. Because race/ethnicity may be a confounder of associations between neighborhood factors and hypertension, future studies that explore interactions between race/ethnicity and neighborhood characteristics will be very useful.