Abstract
ObjectiveWe examined associations between neighborhood socioeconomic disadvantage, perceived neighborhood safety and cardiometabolic risk factors, adjusting for health behaviors and socioeconomic status (SES) among African Americans.MethodsStudy participants were non-diabetic African Americans (n = 3,909) in the baseline examination (2000–2004) of the Jackson Heart Study. We measured eight risk factors: the metabolic syndrome, its five components, insulin resistance and cardiovascular inflammation. We assessed neighborhood socioeconomic disadvantage with US Census 2000 data. We assessed perceived neighborhood safety, health behaviors and SES via survey. We used generalized estimating equations to estimate associations with a random intercept model for neighborhood effects.ResultsAfter adjustment for health behaviors and SES, neighborhood socioeconomic disadvantage was associated with the metabolic syndrome in women (PR 1.13, 95% CI 1.01, 1.27). Lack of perceived safety was associated with elevated glucose (OR 1.36, 95% CI 1.03, 1.80) and waist circumference (PR 1.06, 95% CI 1.02, 1.11) among women, and with elevated glucose (PR 1.30, 95% CI 1.02, 1.66) and insulin resistance (PR 1.25, 95% CI 1.08, 1.46) among men.ConclusionsNeighborhood socioeconomic disadvantage and perceived safety should be considered as targets for intervention to reduce cardiometabolic risks among African Americans.
Highlights
Cardiometabolic risk factors, including abdominal obesity, elevated blood pressure, dyslipidemia, glucose intolerance and inflammation are highly prevalent among African Americans [1,2,3]
National epidemiologic surveillance data suggest that health behaviors such as physical inactivity and diet strongly contribute to the high prevalence of cardiometabolic risk factors seen among African Americans [6]
‘‘loaded’’ on, or were tightly associated with, the first extracted factor which we identified as neighborhood socioeconomic disadvantage: the percentage of adults living in poverty, the civilian unemployment rate, the percentage of households with no car ownership, and the percentage of owner occupied housing in the neighborhood
Summary
Cardiometabolic risk factors, including abdominal obesity, elevated blood pressure, dyslipidemia, glucose intolerance and inflammation are highly prevalent among African Americans [1,2,3]. The residential neighborhood socioeconomic environments to which African Americans are exposed are hypothesized to contribute to cardiometabolic risks in these groups [7]. African Americans in the United States (US) are likely to live in residential environments with high levels of health-related neighborhood socioeconomic disadvantages, including high unemployment and poverty, as well as high levels of perceived social disorder, such as lack of perceived neighborhood safety [12,13]. Neighborhood socioeconomic disadvantage and disorder are theorized to contribute to psychological stress which activates the hypothalamic-pituitary-adrenal (HPA) axis, which may lead to physiologic dysfunction in multiple pathways, including cardiovascular inflammation and metabolic derangements [14,15]
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