Abstract P200: Neighborhood Disadvantage and Poor Social Conditions Influence Cardiovascular Disease Incidence in African American Adults: A Prospective Analysis in the Jackson Heart Study

Abstract

Introduction: Racial residential segregation results in increased exposure to adverse neighborhood environments in African Americans; however the impact of economic and social neighborhood conditions on CVD incidence has not been examined in large, socioeconomically diverse African American samples. Hypothesis: Neighborhood disadvantage and poor social conditions (i.e. violence, physical disorder, and low social cohesion) will be associated with increased risk of developing CVD. Methods: The study included 4,096 African American women and men ages 21-93 from the Jackson Heart Study. Census tracts served as proxies for neighborhoods. Neighborhood disadvantage was assessed using 8 indicators from the 2000 US Census. Neighborhood-level social conditions including social cohesion, violence, and physical disorder were assed using self-reported, validated scales. Multivariable cox-proportional hazards models were used to calculate gender-stratified adjusted hazard ratios and 95% confidence intervals. Results: A total of 232 incident cases of CVD occurred during a median follow-up of 8.38 years. Age-adjusted incidence rates generally increased as neighborhood economic and social conditions worsened for both women and men. Among African American women, each standard deviation increase in neighborhood disadvantage was associated with a 25% increased risk of developing CVD after adjustment for socio-demographic characteristics (HR: 1.25, 95% CI: 1.05-1.49). Risk of developing CVD also increased as levels of neighborhood violence and physical disorder increased after socio-demographic adjustment (HR: 1.13, 95% CI: 1.00-1.28 and HR: 1.20, 95% CI: 1.02-1.40, respectively). No statistically significant associations were observed among African American men in multivariable-adjusted models. Conclusion: In conclusion, worse neighborhood economic and social conditions contributed to increased risk of developing CVD among African American women in our sample. Policies and interventions directly addressing these issues may alleviate the burden of CVD in this group.