Association between neighborhood-level socioeconomic deprivation and incident hypertension: A longitudinal analysis of data from the Dallas heart study

doi:10.1016/j.ahj.2018.07.005

American Heart Journal

Volume 204, October 2018, Pages 109-118

https://doi.org/10.1016/j.ahj.2018.07.005 Get rights and content

Background

Cardiovascular disease is a leading economic and medical burden in the United States (US). As an important risk factor for cardiovascular disease, hypertension represents a critical point of intervention. Less is known about longitudinal effects of neighborhood deprivation on blood pressure outcomes, especially in light of new hypertension guidelines.

Methods

Longitudinal data from the Dallas Heart Study facilitated multilevel regression analysis of the relationship between neighborhood deprivation, blood pressure change, and incident hypertension over a 9-year period. Factor analysis explored neighborhood perception, which was controlled for in all analyses. Neighborhood deprivation was derived from US Census data and divided into tertiles for analysis. Hypertension status was compared using pre-2017 and 2017 hypertension guidelines.

Results

After adjusting for covariates, including moving status and residential self-selection, we observed significant associations between residing in the more deprived neighborhoods and 1) increasing blood pressure over time and 2) incident hypertension. In the fully adjusted model of continuous blood pressure change, significant relationships were seen for both medium (SBP: β = 4.81, SE = 1.39, P = .0005; DBP: β = 2.61, SE = 0.71, P = .0003) and high deprivation (SBP: β = 7.64, SE = 1.55, P < .0001; DBP: β = 4.64, SE = 0.78, P < .0001). In the fully adjusted model of incident hypertension, participants in areas of high deprivation had 1.69 higher odds of developing HTN (OR 1.69; 95% CI 1.02, 2.82), as defined by 2017 hypertension guidelines. Results varied based on definition of hypertension used (pre-2017 vs. 2017 guidelines).

Conclusion

These findings highlight the potential impact of adverse neighborhood conditions on cardiometabolic outcomes, such as hypertension.

Section snippets

Dallas heart study (DHS)

The DHS is composed of a multi-ethnic cohort of Dallas County residents ages 18–65 years at baseline and is designed to study cardiovascular disease risk and outcomes. Probability sampling was used to establish the cohort, and African Americans were intentionally oversampled to comprise 50% of the study cohort. This was done to ensure a sufficient cohort of African Americans for analyses by race/ethnicity. Baseline data collection took place from 2000–2002. Detailed data collection methods have

Results

Neighborhood characteristics for the census tracts included in analysis are shown in Table I. Significant differences were observed across tertiles of NDI in all variables.

The study population (n = 1989) consisted of 50% non-Hispanic blacks, 30% non-Hispanic whites, and 20% Hispanic whites. Median follow-up time between the study visits was 7 years. Table II shows population characteristics at baseline, representing a cross-sectional snapshot of the cohort. The NDI distribution ranged from

Discussion

This study adds to the discussion of combatting cardiovascular disease by focusing on the effects of exposure to a deprived neighborhood environment. First, it corroborates existing cross-sectional evidence by demonstrating higher blood pressure and HTN 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 HTN while controlling for movement between neighborhoods and

Conclusions

Our study adds to the small but nascent literature on the effects of neighborhood deprivation on HTN incidence, especially in the U.S. The findings suggest that public policy targeting neighborhood-level factors, such as the neighborhood physical environment and available community resources, within Dallas County may be beneficial in improving the cardiovascular health of residents. While improvements to sidewalks, food resources, and recreational areas may substantially improve cardiovascular

Conflicts of interest

none.

Author contributions

Sophie E. Claudel participated in the data analysis and writing the manuscript. Joel Adu-Brimpong participated in the study design, data analysis and drafted the manuscript. Alnesha Banks participated in drafting and reviewing the manuscript. Colby Ayers performed all statistical analyses and contributed to the drafting of the manuscript. Michelle A. Albert, Sandeep Das, James A. de Lemos, Tammy Leonard, Ian J. Neeland and Joshua P. Rivers participated in study design and reviewed analyzed data

Funding

The Powell-Wiley research group is funded by the Division of Intramural Research of the National Heart, Lung, and Blood Institute and the Intramural Research Program of the National Institute of Minority Health and Health Disparities at the National Institutes of Health. This research is also supported by the National Institutes of Health Undergraduate Scholarship Program via funding for Joel Adu-Brimpong and the U.S. Health Resources and Services Administration (HRSA), D34HP16299 (Dr.

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Hypertension impacts nearly one billion individuals and is a primary health challenge. While traditional perspectives have focused on individual behavior and genetics as principal risk factors, recent research underscores the profound influence of socioeconomic factors within neighborhoods on the risk of hypertension. This systematic review and meta-analysis is aimed to elucidate the association between neighborhood deprivation and the risk of hypertension.
A comprehensive literature search was conducted across PubMed, Embase, and Web of Science from inception until December 25, 2023. Observational studies defining neighborhood deprivation and reporting hypertension incidence were included. Nested Knowledge software was used for screening and data extraction, with study quality assessed using the Newcastle-Ottawa Scale. Statistical analysis was performed with R software (V 4.3), using a random-effects model to calculate the pooled relative risk (RR).
Twenty-six studies were included in the qualitative analysis and 22 in the meta-analysis, covering over 62 million participants. The pooled RR was 1.139 (95% CI: 1.006 – 1.290), p=0.04, indicating a higher hypertension risk in deprived neighborhoods. Subgroup analyses showed variability by country and deprivation assessment methods. RR varied from 1.00 in Japan (95% CI: 0.93–1.08) to 1.60 (95% CI: 1.07–2.39) in France and 1.57 (95% CI: 0.67–3.70) in Germany, with significant heterogeneity observed in measures of neighborhood deprivation.
Our analysis confirms a significant association between neighborhood deprivation and hypertension, underscoring the importance of socioeconomic factors in public health. It highlights the need for targeted local assessments and interventions. Future research should explore the causal mechanisms and effectiveness of interventions addressing neighborhood deprivation.
Associations between dimensions of the social environment and cardiometabolic risk factors: Systematic review and meta-analysis
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The social environment (SE), including social contacts, norms and support, is an understudied element of the living environment which impacts health. We aim to comprehensively summarize the evidence on the association between the SE and risk factors of cardiometabolic disease (CMD).
We performed a systematic review and meta-analysis based on studies published in PubMed, Scopus and Web of Science Core Collection from inception to 16 February 2021. Studies that used a risk factor of CMD, e.g., HbA1c or blood pressure, as outcome and social environmental factors such as area-level deprivation or social network size as independent variables were included. Titles and abstracts were screened in duplicate. Study quality was assessed using the Newcastle-Ottawa Scale. Data appraisal and extraction were based on the study protocol published in PROSPERO. Data were synthesized through vote counting and meta-analyses.
From the 7521 records screened, 168 studies reported 1050 associations were included in this review. Four meta-analyses based on 24 associations suggested that an unfavorable social environment was associated with increased risk of cardiometabolic risk factors, with three of them being statistically significant. For example, individuals that experienced more economic and social disadvantage had a higher “CVD risk scores” (OR = 1.54, 95%CI: 1.35 to 1.84). Of the 458 associations included in the vote counting, 323 (71%) pointed towards unfavorable social environments being associated with higher CMD risk.
Higher economic and social disadvantage seem to contribute to unfavorable CMD risk factor profiles, while evidence for other dimensions of the social environment is limited.
Impact of Environmental Factors on Hypertension and Associated Cardiovascular Disease
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Hypertension is the primary cause of cardiovascular diseases and is responsible for nearly 9 million deaths worldwide annually. Increasing evidence indicates that in addition to pathophysiologic processes, numerous environmental factors, such as geographic location, lifestyle choices, socioeconomic status, and cultural practices, influence the risk, progression, and severity of hypertension, even in the absence of genetic risk factors. In this review, we discuss the impact of some environmental determinants on hypertension. We focus on clinical data from large population studies and discuss some potential molecular and cellular mechanisms. We highlight how these environmental determinants are interconnected, as small changes in one factor might affect others, and further affect cardiovascular health. In addition, we discuss the crucial impact of socioeconomic factors and how these determinants influence diverse communities with economic disparities. Finally, we address opportunities and challenges for new research to address gaps in knowledge on understanding molecular mechanisms whereby environmental factors influence development of hypertension and associated cardiovascular disease.
L’hypertension qui est la principale cause des maladies cardiovasculaires (MCV) est responsable de près de neuf millions de morts par année dans le monde. De plus en plus de données probantes montrent qu’en plus des processus physiopathologiques, de nombreux facteurs environnementaux tels que la situation géographique, les choix relatifs au mode de vie, le statut socioéconomique et les pratiques culturelles influencent le risque, la progression et la gravité de l’hypertension, même en l’absence de facteurs de risque génétiques. Dans le présent article, nous traitons des répercussions de certains déterminants environnementaux sur l’hypertension. Nous portons notre attention sur les données cliniques de vastes études de population et examinons certains mécanismes moléculaires et cellulaires potentiels. Nous décrivons comment ces déterminants environnementaux sont interreliés, et comment de petits changements dans l’un des facteurs pourraient avoir des répercussions sur les autres, et nuire davantage à la santé cardiovasculaire. De plus, nous traitons des importantes répercussions des facteurs socioéconomiques et de la façon dont ces déterminants influencent les diverses communautés marquées par des disparités économiques. Finalement, nous nous penchons sur les possibilités et les enjeux des nouvelles recherches à combler les lacunes dans les connaissances en matière de compréhension des mécanismes moléculaires par lesquelles les facteurs environnementaux influencent l’apparition de l’hypertension et des maladies cardiovasculaires associées.
Epigenetic age acceleration mediates the relationship between neighborhood deprivation and pain severity in adults with or at risk for knee osteoarthritis pain
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An estimated 250 million people worldwide suffer from knee osteoarthritis (KOA), with older adults having greater risk. Like other age-related diseases, residents of high-deprivation neighborhoods experience worse KOA pain outcomes compared to their more affluent neighbors. The purpose of this study was to examine the relationship between neighborhood deprivation and pain severity in KOA and the influence of epigenetic age acceleration (EpAA) on that relationship. The sample of 128 participants was mostly female (60.9%), approximately half non-Hispanic Black (49.2%), and had a mean age of 58 years. Spearman bivariate correlations revealed that pain severity positively correlated with EpAA (ρ = 0.47, p ≤ 0.001) and neighborhood deprivation (ρ = 0.25, p = 0.004). We found a positive significant relationship between neighborhood deprivation and EpAA (ρ = 0.47, p ≤ 0.001). Results indicate a mediating relationship between neighborhood deprivation (predictor), EpAA (mediator), and pain severity (outcome variable). There was a significant indirect effect of neighborhood deprivation on pain severity through EpAA, as the mediator accounted for a moderate portion of the total effect, PM = 0.44. Epigenetic age acceleration may act as a mechanism through which neighborhood deprivation leads to worse KOA pain outcomes and may play a role in the well-documented relationship between the neighborhood of residence and age-related diseases.
Longitudinal profiles of neighborhood socioeconomic vulnerability influence blood pressure changes across the female midlife period
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To examine whether longitudinal exposure to neighborhood socioeconomic vulnerability influences blood pressure changes throughout midlife in a racially, ethnically, and geographically-diverse cohort of women transitioning through menopause.
We used longitudinal data on 2738 women (age 42–52 at baseline) living in six United States cities from The Study of Women's Health Across the Nation. Residential histories, systolic blood pressures (SBP), and diastolic blood pressures (DBP) were collected annually for ten years. We used longitudinal latent profile analysis to identify patterns of neighborhood socioeconomic vulnerability occurring from 1996 to 2007 in participant neighborhoods. We used linear mixed-effect models to determine if a woman's neighborhood profile throughout midlife was associated with blood pressure changes.
We identified four unique profiles of neighborhood socioeconomic vulnerability – differentiated by residential socioeconomic status, population density, and vacant housing conditions – which remained stable across time. Women residing in the most socioeconomically vulnerable neighborhoods experienced the steepest increase in annual SBP growth by 0.93 mmHg/year (95% CI: 0.65–1.21) across ten-year follow-up.
Neighborhood socioeconomic vulnerability was significantly associated with accelerated SBP increases throughout midlife among women.
Long-term aircraft noise exposure and risk of hypertension in postmenopausal women
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Citation Excerpt :
These discrepancies may be related to differences in study design (e.g. cross-sectional vs. cohort), case definition (e.g. self-report of hypertension vs. blood pressure measurements), study population, noise exposure estimation protocols, and opportunities for residual confounding (Huang et al., 2015; van Kempen et al., 2018). There are also indications of sociodemographic disparities in noise exposure around U.S. airports (Simon et al., 2022) and in hypertension prevalence and incidence (Aggarwal et al., 2021; Claudel et al., 2018; Lackland, 2014) that warrant consideration in epidemiological studies. Accordingly, we utilized modeled aircraft noise data from 90 U.S. airports to assess the longitudinal association between exposure to aircraft noise and incident hypertension in the Women's Health Initiative (WHI) Clinical Trials.
Studies of the association between aircraft noise and hypertension are complicated by inadequate control for potential confounders and a lack of longitudinal assessments, and existing evidence is inconclusive.
We evaluated the association between long-term aircraft noise exposure and risk of hypertension among post-menopausal women in the Women's Health Initiative Clinical Trials, an ongoing prospective U.S. cohort.
Day-night average (DNL) and night equivalent sound levels (L_night) were modeled for 90 U.S. airports from 1995 to 2010 in 5-year intervals using the Aviation Environmental Design Tool and linked to participant geocoded addresses from 1993 to 2010. Participants with modeled exposures ≥45 A-weighted decibels (dB [A]) were considered exposed, and those outside of 45 dB(A) who also did not live in close proximity to unmodeled airports were considered unexposed. Hypertension was defined as systolic/diastolic blood pressure ≥140/90 mmHg or inventoried/self-reported antihypertensive medication use. Using time-varying Cox proportional hazards models, we estimated hazard ratios (HRs) for incident hypertension when exposed to DNL or L_night ≥45 versus <45 dB(A), controlling for sociodemographic, behavioral, and environmental/contextual factors.
There were 18,783 participants with non-missing DNL exposure and 14,443 with non-missing L_night exposure at risk of hypertension. In adjusted models, DNL and L_night ≥45 db(A) were associated with HRs of 1.00 (95% confidence interval [CI]: 0.93, 1.08) and 1.06 (95%CI: 0.91, 1.24), respectively. There was no evidence supporting a positive exposure-response relationship, and findings were robust in sensitivity analyses. Indications of elevated risk were seen among certain subgroups, such as those living in areas with lower population density (HR_interaction: 0.84; 95%CI: 0.72, 0.98) or nitrogen dioxide concentrations (HR_interaction: 0.82; 95%CI: 0.71, 0.95), which may indicate lower ambient/road traffic noise. Our findings do not suggest a relationship between aircraft noise and incident hypertension among older women in the U.S., though associations in lower ambient noise settings merit further investigation.

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Clinical InvestigationAssociation between neighborhood-level socioeconomic deprivation and incident hypertension: A longitudinal analysis of data from the Dallas heart study

Background

Methods

Results

Conclusion

Section snippets

Dallas heart study (DHS)

Results

Discussion

Conclusions

Conflicts of interest

Author contributions

Funding

Prev Med (Baltim)

Am J Prev Med

Soc Sci Med

Psychol Sport Exerc

J Environ Psychol

Prev Med Rep

Am J Cardiol

Prev Med (Baltim)

Soc Sci Med

Health Place

Adv Chronic Kidney Dis

2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practic

Hypertension

How Does Blood Pressure Cause Stroke?

Lancet

Framingham Study Insights on the Hazards of Elevated Blood Pressure

JAMA

Blood pressure variability and the risk of all-cause mortality, incident myocardial infarction, and incident stroke in the cardiovascular health study

Am J Hypertens

Blood Pressure Components and the Risk for End-Stage Renal Disease and Death in Chronic Kidney Disease

Clin J Am Soc Nephrol

Neighborhood stressors and race/ethnic differences in hypertension prevalence (the Multi-Ethnic Study of Atherosclerosis)

Am J Hypertens

Neighborhood characteristics and hypertension

Epidemiology

Neighborhood Environments and Incident Hypertension in the Multi-Ethnic Study of Atherosclerosis

Am J Epidemiol

Childhood psychosocial adversity and adult neighborhood disadvantage as predictors of cardiovascular disease: A cohort study

Circulation

Residential Environments and Cardiovascular Risk

J Urban Health

Clinical Investigation
Association between neighborhood-level socioeconomic deprivation and incident hypertension: A longitudinal analysis of data from the Dallas heart study