Background Racial residential segregation has been linked to adverse health outcomes, but associations may operate through multiple pathways. Prior studies have not examined associations of neighbourhood-level racial segregation with an index of cardiometabolic risk (CMR) and whether associations differ by race/ethnicity.
Methods We used data from the Multi-Ethnic Study of Atherosclerosis to estimate cross-sectional and longitudinal associations of baseline neighbourhood-level racial residential segregation with a composite measure of CMR. Participants included 5015 non-Hispanic black, non-Hispanic white and Hispanic participants aged 45–84 years old over 12 years of follow-up (2000–2012). We used linear mixed effects models to estimate race-stratified associations of own-group segregation with CMR at baseline and with the rate of annual change in CMR. Models were adjusted for sociodemographics, medication use and individual-level and neighbourhood-level socioeconomic status (SES).
Results In models adjusted for sociodemographics and medication use, high baseline segregation was associated with higher baseline CMR among blacks and Hispanics but lower baseline CMR among whites. Individual and neighbourhood-level SES fully explained observed associations between segregation and CMR for whites and Hispanics. However, associations of segregation with CMR among blacks remained (high vs low segregation: mean difference 0.17 SD units, 95% CI 0.02 to 0.32; medium vs low segregation: mean difference 0.18 SD units, 95% CI 0.03 to 0.33). Baseline segregation was not associated with change in CMR index scores over time.
Conclusion Associations of own-group racial residential segregation with CMR varied by race/ethnicity. After accounting for SES, living in a more segregated neighbourhood was associated with greater risk among black participants only.
- longitudinal studies
- social epidemiology
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Contributors SLM analysed the data, drafted the manuscript and contributed to planning the analysis. MTH conceptualised the study and contributed to planning the analysis and drafting the manuscript. KNK contributed to planning the analysis. SSM, TES and AVDR contributed to data acquisition and generation. All authors contributed analytic suggestions, interpretation of results, critically revised drafts of the manuscript and approved the final version for publication.
Funding This research was supported by contracts HHSN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169 from the National Heart, Lung, and Blood Institute (NHLBI) and by grants UL1-TR-000040, UL1-TR-001079 and UL1-TR-001420 from National Center for Advancing Translational Sciences (NCATS), both at the National Institutes of Health. This research was also partially supported by contracts P60 MD002249-05 (National Institute of Minority Health and Health Disparities) and R01 HL071759 (NHLBI), and an NHLBI Training Grant in Cardiovascular Epidemiology and Prevention (T32HL069771).
Disclaimer The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the U.S. Department of Health and Human Services.
Competing interests None declared.
Patient consent Not required.
Ethics approval Columbia University, Johns Hopkins University, Northwestern University, UCLA, University of Minnesota, Wake Forest University.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The Multi-Ethnic Study of Atherosclerosis (MESA) has hundreds of investigators, many active scientific working groups (on renal disease, eye disease and other topics) and dozens of ongoing analytic projects. The authors are always looking for outside investigators interested in using the data to answer their research questions. To help interested parties navigate the data and topics and find fruitful collaborations, they encourage you to contact the Coordinating Center or a MESA investigator. Here is a link to the website for more details: http://www.mesa-nhlbi.org/.
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