Neighborhood disadvantage linked to high rate of hypertension, low rate of treatment
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Key takeaways:
- Neighborhood disadvantage was tied to increased hypertension prevalence and decreased treatment.
- The association was particularly strong among women and Black people living in areas with high deprivation levels.
Neighborhoods with higher socioeconomic disadvantage, particularly predominantly Black areas, had higher rates of hypertension and lower rates of BP treatment vs. less disadvantaged neighborhoods, researchers reported.
Research that evaluated the prevalence and treatment of hypertension across varying levels of neighborhood-level deprivation was published in JAMA Network Open.
“We and others — including the CDC — have done previous work to document the severity of neighborhood-level disparities in life expectancy. In Cuyahoga County, Ohio, according to CDC estimates, the individual neighborhoods with the lowest and highest life expectancy are only 1.2 miles apart, and the life expectancy difference is 2.5 decades,” Jarrod E. Dalton, PhD, director of the Center for Populations Health Research at the Cleveland Clinic Lerner Research Institute, told Healio. “To put this in perspective, that's an entire generation. We wanted to move upstream and begin to understand differences in chronic disease in mid-life, particularly hypertension, which is a precursor to other chronic diseases that also show neighborhood-level patterns.”
‘Intersectionality of neighborhood racial composition’ and BP
The researchers evaluated variations in hypertension among middle-aged adults by race/ethnicity across levels of neighborhood disadvantage.
The cross-sectional study included data from 56,387 middle-aged adults (median age, 43 years; 60% women) across 1,157 neighborhoods in Cuyahoga County, Ohio, who attended a primary care visit in 2019. Participants’ geocoded electronic health record data were linked to the deprivation index of their respective area of residences, based on U.S. Census data. The area deprivation index (ADI) includes measures of income, education, housing and occupation. The primary outcome was diagnosis of essential hypertension.
The overall cohort was approximately 3% Asian, 31% Black, 6% Hispanic and 60% white.
The rate of hypertension in high ADI neighborhoods was 50.7% compared with 25.5% in those with low ADI neighborhoods.
The rate of hypertension treatment was a little lower in high ADI neighborhoods (61.3%) compared with low ADI neighborhoods (64.5%).
Among predominantly Black neighborhoods, 63% had a hypertension rate of more than 35% and a treatment rate of less than 70%; however, only 11.8% of neighborhoods with a Black population of 5% or less met these same criteria, according to the study.
ADI and proportion of Black population accounted for more than 90% of variation in hypertension rate for both men and women.
“The intersectionality of neighborhood racial composition and hypertension prevalence in Cuyahoga County is severe, and the Black neighborhoods with the highest hypertension prevalence were in many cases the same neighborhoods that were most severely impacted by racial residential segregation going back to the early 20th century,” Dalton told Healio. “We identified particular neighborhoods that not only had high hypertension prevalence in midlife, but also low antihypertensive medication prescription rates. The results highlight the need to intervene in ways that go beyond guideline-concordant prevention in the face-to-face care encounter setting, for example, through multi-sector population prevention initiatives.”
Moreover, the association between ADI and risk for hypertension was strongest for women, but differences were smallest between Black men and women, particularly among those living in areas with the highest deprivation index (60% for men vs. 56% for women).
Surprising ‘starkness of the disparities’
“We suspected that, when we looked at neighborhood patterns of hypertension and antihypertensive medication treatment in our respective health systems' clinical populations, we would identify patterns that generally corresponded with estimates from national models,” Dalton said. “However, the starkness of the disparities that we observed within Cuyahoga County — particularly Cleveland, which is one of the poorest cities in the country — was surprising.
“Based on these findings, Cleveland Clinic is beginning to develop community intervention and outreach programs targeted towards neighborhoods identified in the research,” he said. “The map detailing areas with high levels of untreated hypertension [found in the full text of the study] can be used as a starting point to develop blood pressure interventions tailored to individual communities.”
For more information:
Jarrod E. Dalton, PhD, can be reached at 9500 Euclid Ave., Mail Code NB21, Cleveland, OH 44196.
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