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Hypertension incidence higher in socioeconomically deprived neighborhoods
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Those residing in socioeconomically deprived neighborhoods may be at greater risk for high BP and increased odds of developing hypertension, according to a study published in the American Heart Journal.
“This study adds to the discussion of combatting cardiovascular disease by focusing on the effects of exposure to a deprived neighborhood environment,” Sophie E. Claudel, BS, of the NHLBI, and colleagues wrote. “First, it corroborates existing cross-sectional evidence by demonstrating higher blood pressure and [hypertension] prevalence at baseline within areas of high deprivation. Second, to our knowledge, it is the first to show a longitudinal relationship between neighborhood deprivation and incident [hypertension] while controlling for movement between neighborhoods and residents’ perception of the environment. Furthermore, this study is one of the first to assess the impact of the new 2017 definitions of [hypertension] in clinical epidemiologic research.”
Longitudinal analysis
To examine the association between BP, incident hypertension and neighborhood deprivation, researchers conducted a multilevel regression longitudinal analysis of data of 1,174 participants aged 18 to 65 years from the Dallas Heart Study between 2000 and 2009 (50% black; 31% white; 19% Hispanic).
Researchers collected data related to medical history, demographics (including household income, education and smoking status) and length of residence in neighborhood. BMI, the presence of hypertension and BP were also recorded.
Next, a block group-level neighborhood deprivation index was formed using 21 variables from the 2000 U.S. Census Bureau, including education, employment/occupation, housing conditions, income/poverty, racial composition and residential stability. Participants were stratified into tertiles of low, medium or high neighborhood deprivation.
In addition, researchers assessed neighborhood perception through participants’ responses to questions that focused on social cohesion, feelings of safety, criminal activity and physical environment characteristics (for instance, access to resources). Neighborhood perception was controlled for in all analyses.
For participants without baseline hypertension, changes in systolic and diastolic BP were monitored across tertiles of neighborhood deprivation over time through use of repeated-measures linear mixed modeling. Researchers used logistic regression modeling to determine the odds of incident hypertension by tertile of neighborhood deprivation.
The researchers found that individuals residing in neighborhoods in the higher tertiles of deprivation were more likely to be black, have lower education, lower income and higher BMI than those living in neighborhoods from the other tertiles.
Deprivation and BP
Residing in areas of greater socioeconomic deprivation was also associated with higher systolic BP (124 mm Hg in low tertile vs. 128 mm Hg in medium tertile vs. 132 mm Hg in highest tertile; P < .0001), higher diastolic BP (78 vs. 79 vs. 82 mm Hg, respectively; P < .0001) and higher prevalence of hypertension based on pre-2017 hypertension guidelines (23.4% vs. 35.1% vs. 43.6%, respectively; P < .0001).
BP also increased throughout the duration of the study in participants in medium (systolic BP: beta = 4.81; standard error = 1.39; P = .0005; diastolic BP: beta = 2.61; standard error = 0.71; P = .0003) and high (systolic BP: beta = 7.64; standard error = 1.55; P < .0001; diastolic BP: beta = 4.64; standard error = 0.78; P < .0001) areas of neighborhood deprivation.
When using the 2017 hypertension guidelines, participants in areas of high deprivation were more likely to develop hypertension (fully adjusted model of high deprivation: OR = 1.69; 95% CI, 1.02-2.82).
“By showing a significant relationship between blood pressure and measures of neighborhood deprivation, which includes factors pertaining to the physical environment, this study adds to the existing literature regarding the potential importance of improvements in the built environment on [hypertension] development,” the researchers wrote. “These findings suggest population-based [hypertension] intervention efforts in low-resource, socioeconomically deprived communities may benefit from improved changes in the built environment, including access to community resources.” – by Melissa J. Webb
Disclosure s : The authors report no relevant financial disclosures.
Perspective
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Viola Vaccarino, MD, PhD
Neighborhood environment, with special consideration to poverty and built environment deprivation characteristics, has been related to CV risk factors before, but studies have been mostly cross-sectional. This study adds a prospective design component, by examining incident hypertension with respect to an index of neighborhood socioeconomic deprivation. Comparing high deprivation to low deprivation categories, the odds for new hypertension were more than 70% higher, after adjusting for sociodemographic variables including individual income and education and other CV risk factors at baseline. These data suggest that there is an important element of risk related to overall neighborhood socioeconomic characteristics that goes beyond individual socioeconomic status.
In the context of all the research published so far linking neighborhood quality to CV health, these findings imply that even in the clinical settings, attention should be given to the environmental characteristics patients live in. For example, encouraging regular physical activity will not be as effective for patients living in deprived areas where there is little opportunity to safely walk outside. Similarly, patients living in deprived areas will have fewer opportunities to access healthy, affordable foods.
This study, like several others based on census data, examined general neighborhood characteristics mostly related to poverty, but does not clarify which aspects are most important for CV risk. Things like walkability, presence of healthy food stores, crime rate, noise, pollution, segregation, stress and social connections are all potentially implicated. Most studies, like this one, have used proxies for these risk factors by analyzing census data of the sociodemographic distribution of specific areas, without getting into the real potential causes. In addition, to date little is known if these risks differ by subgroups (by sex and race, for example), and if they help explain the large disparities in CV mortality that exist based on race and geographic region in the United States.
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