Declining neighborhood conditions associated with increased CVD risk in black women

As a neighborhood’s socioeconomic status and social condition decrease, the risk for CVD in black women within the community increases, according to new data from the Jackson Heart Study.

The relationship was not statistically significant in black men, researchers reported.

“Although a number of studies have examined how neighborhood economic and, to a lesser

extent, social conditions influence CVD risk and onset longitudinally, prospective analyses among African Americans remain sparse and findings have been mixed,” Sharrelle Barber, ScD, MPH, a research fellow at Drexel University School of Public Health in Philadelphia, and colleagues wrote.

Barber and colleagues examined associations between neighborhood economic and social environment and CVD incidence.

The researchers analyzed black individuals (men, n = 1,444; women, n = 2,652) aged 21 to 93 years living in Jackson, Mississippi, from 2000 to 2004. Average follow-up was 8.38 years.

Neighborhood disadvantage was assessed through eight indicators gathered from the 2000 U.S. Census. Neighborhood-level social conditions were obtained through self-reported, validated scales and included social cohesion, violence and disorder.

Demographic characteristics

During the study period, 232 CVD events occurred. Compared with those who did not, individuals who developed CVD were older, resided in more disadvantaged neighborhoods and neighborhoods with higher levels of violence and disorder, and had less family income, education and generally worse risk factor profiles, Barber and colleagues wrote.

Among black women, there was a 25% increase in incidence of CVD for each standard deviation increase in neighborhood disadvantage (HR = 1.25; 95% CI, 1.05-1.49) after adjustment for sociodemographic characteristics. After adjustment for CVD risk factors, the risk was attenuated but remained statistically significant (HR = 1.23; 95% CI, 1.04-1.45).

Black men showed a similar pattern, but the associations were not statistically significant (HR after adjustment for sociodemographic characteristics = 1.08; 95% CI, 0.82-1.41; HR after adjustment for CVD risk factors = 1.03; 95% CI, 0.79-1.36), according to the researchers.

Increases in neighborhood violence and disorder were associated with an increased risk for CVD in black women (HR for violence = 1.13; 95% CI, 1-1.28; HR for disorder = 1.2; 95% CI, 1.02-1.4), Barber and colleagues wrote.

In black men, living in neighborhoods with violence and disorder was associated with a decreased risk for CVD, but the association was not statistically significant.

Relationship with stroke

Neighborhood disadvantage and social environment were also associated with stroke in black women (HR for neighborhood disadvantage = 1.23; 95% CI, 1-1.5; HR for social cohesion = 1.17; 95% CI, 1-1.37; HR for violence = 1.21; 95% CI, 1.03-1.41; HR for disorder = 1.31; 95% CI, 1.08-1.6), but not CHD.

“Although access to health-promoting resources may be important, it is only one part of the equation, and prevention efforts that only focus on these features may be undermined without careful consideration of the broader economic and social conditions that also contribute to CVD risk,” the researchers wrote. “Thus, neighborhood-level policy efforts directly addressing economic and social conditions should be considered as viable strategies to reduce the burden of CVD among African Americans and ultimately mitigate observed racial inequities in this group.” – by Cassie Homer

Disclosure: The researchers report no relevant financial disclosures.