Neighborhood Socioeconomic Factors Research Articles

Abstract WP180: The Association between Neighborhood Socioeconomic Disadvantage, Fish Consumption, and Stroke Risk Factors: the Cardiovascular Health Study

Background: Fish consumption has been associated with reduced risk of stroke, and residence in low income neighborhoods has been associated with higher risk of stroke, either directly or through biologic risk factors for stroke, such as hypertension, diabetes, and subclinical disease. No studies, however, have examined the relationship between neighborhood characteristics, fish consumption, and stroke risk factors. Methods: We analyzed data from 3907 adults from the Cardiovascular Health Study (CHS), a population-based, longitudinal study of adults ages ≥65 years from 4 US counties. The outcomes were fish consumption (non-fried fish: ≥5 times/wk, 1-4 times/wk, 1-3 times/mo, <1 time/mo; fried fish: ≥1 times/wk, 1-3 times/mo, <1 time/mo) and stroke risk factors (Framingham stroke risk score [FSRS], diabetes, subclinical CVD [sCVD], hypertension). Neighborhood socioeconomic status (NSES) was measured using a composite of 6 census variables. Hierarchical generalized mixed-effects regression models with census-level random-effects were fit to continuous, binary, and ordinal outcomes adjusted for sociodemographic characteristics. Results: In adjusted analyses, residents of the most disadvantaged neighborhoods had lower consumption of non-fried fish (OR=0.55, 95% CI: 0.41-0.74) and higher consumption of fried fish (OR=1.61, 1.28-2.03). Eating non-fried fish was independently associated with a lower stroke risk score, but not with diabetes, hypertension, or sCVD. However, these relationships differed by neighborhood. Among those who consumed non-fried fish 1-4 times/wk, residents of the most disadvantaged neighborhoods had higher odds of diabetes (OR=1.78; p=0.03) and sCVD (OR=1.59; p=0.003), a trend towards higher odds of hypertension (OR=1.33; p=.054), and a higher FSRS (OR=1.09; p=.03). Eating fried fish was not associated with differences in stroke risk factors or FSRS. Conclusions: Residents of disadvantaged neighborhoods consumed less non-fried fish and more fried fish. Even with the same level of non-fried fish consumption, residents of more disadvantaged neighborhoods did not get the same benefit in stroke risk reduction as residents of higher SES neighborhoods.

Does neighbourhood social capital aid in levelling the social gradient in the health and well-being of children and adolescents? A literature review

BackgroundAlthough most countries in the European Union are richer and healthier than ever, health inequalities remain an important public health challenge. Health-related problems and premature death have disproportionately been reported in disadvantaged neighbourhoods. Neighbourhood social capital is believed to influence the association between neighbourhood deprivation and health in children and adolescents, making it a potentially interesting concept for policymakers.MethodsThis study aims to review the role of social capital in health inequalities and the social gradient in health and well-being of children and adolescents. A systematic review of published quantitative literature was conducted, focussing on (1) the mediating role of neighbourhood social capital in the relationship between socio-economic status (SES) and health-related outcomes in children and adolescents and (2) the interaction between neighbourhood social capital and socio-economic characteristics in relation to health-related outcomes in children and adolescents. Three electronic databases were searched. Studies executed between 1 January 1990 and 1 September 2011 in Western countries (USA, New Zealand, Australia and Europe) that included a health-related outcome in children or adolescents and a variable that measured neighbourhood social capital were included.ResultsEight studies met the inclusion criteria for the review. The findings are mixed. Only two of five studies confirmed that neighbourhood social capital mediates the association between neighbourhood deprivation and health and well-being in adolescents. Furthermore, two studies found a significant interaction between neighbourhood socio-economic factors and neighbourhood social capital, which indicates that neighbourhood social capital is especially beneficial for children who reside in deprived neighbourhoods. However, two other studies did not find a significant interaction between SES and neighbourhood social capital. Due to the broad range of studied health-related outcomes, the different operationalisations of neighbourhood social capital and the conceptual overlap between measures of SES and social capital in some studies, the factors that explain these differences in findings remain unclear.ConclusionsAlthough the findings of this study should be interpreted with caution, the results suggest that neighbourhood social capital might play a role in the health gradient among children and adolescents. However, only two of the included studies were conducted in Europe. Furthermore, some studies focussed on specific populations and minority groups. To formulate relevant European policy recommendations, further European-focussed research on this issue is needed.

Cumulative Exposure to Neighborhood Context

Over the last two decades, research has assessed the relationship between neighborhood socioeconomic factors and individual health. However, existing research is based almost exclusively on cross-sectional data, ignoring the complexity in health transitions that may be shaped by long-term residential exposures. We address these limitations by specifying distinct health transitions over multiple waves of a 15-year study of American adults. We focus on transitions between a hierarchy of health states, (free from health problems, onset of health problems, and death), not just gradients in a single health indicator over time, and use a cumulative measure of exposure to neighborhoods over adulthood. We find that cumulative exposure to neighborhood disadvantage has significant effects on functional decline and mortality. Research ignoring a persons' history of exposure to residential contexts over the life course runs the risk of underestimating the role of neighborhood disadvantage on health.

Neighborhood socioeconomic disparities and 1-year case fatality after incident myocardial infarction: The Atherosclerosis Risk in Communities (ARIC) Community Surveillance (1992-2002)

Declines in case fatality post-myocardial infarction (MI) have been observed over the past 3 decades. Few studies report socioeconomic disparities in survival post-MI. We assessed 1-year case fatality among 9,116 incident MI patients included in the Atherosclerosis Risk in Communities community surveillance from 1992 to 2002. Addresses of hospitalized MI patients were geocoded by a commercial vendor and linked to year 2000 United States Census tract-level neighborhood income (nINC) data. We estimated case fatality odds ratios and 95% CIs with a multinomial logistic model to quantify the association between nINC tertile and case fatality, comparing short- (within 28 days) and long-term (29-365 days) case fatality to no death 1 year post-MI. Overall, 1-year age-adjusted case fatality rates were highest among MI patients living in low-nINC areas, followed by medium- and high-nINC areas, respectively. We found significant odds ratio modification by race (P < .10) and formed race-nINC strata with high-nINC whites as the referent group. In multivariable models adjusting for age, gender, study community, and year of MI, low-nINC whites and low- and medium-nINC blacks had higher short-term case fatality than high-nINC whites. Low- and medium-nINC blacks had higher long-term case fatality compared with high-nINC whites. Differences in short- and long-term case fatality by neighborhood socioeconomic factors have not been systematically studied in the United States. Surveillance efforts can be expanded to incorporate measures of the neighborhood context to examine these associations over time.

Influence of built environment and transportation access on body mass index of older adults: Survey results from Erie County, New York

Recent empirical research about the influence of built environments on individual health behaviors and health conditions focuses on people of all ages or youth subgroups (such as children and adolescents) but infrequently on older adults. To address the gap, the impact of built environment characteristics—such as population density, land use arrangements, and access to public transit—on body mass index (BMI) is assessed for 207 older adults (age 50 and older) in Erie County, New York. A particular focus of inquiry is how frequency of driving and access to public transportation—and the degree to which various urban forms provide support for these mode choices—relate to BMI for older adults. Socio-demographic data and information about individuals' health is collected using a random survey of older adults; data about the built environment is calculated for the surroundings of each respondent's home using Geographic Information Systems (GIS). Results from ordinary least squares regression models suggest that BMI of older adults may be more influenced by personal characteristics—age, sex, physical functionality—and neighborhood socioeconomic factors—share of population within the respondents' census tract that is white, and median household income—than by neighborhood land use and frequency of driving. Access to public transportation—measured by the density of nearby bus stops—exhibits an inverse and statistically significant relationship with BMI among older adults, suggesting that transportation access may play a greater role in the overall activity levels and BMI of older adults.

SOCIAL INEQUALITIES IN CHILDREN’S ENVIRONMENTAL QUALITY: THE IMPACT OF INDIVIDUAL SOCIAL CHARACTERISTICS AND FACTORS OF THE NEIGHBOURHOOD SOCIOECONOMIC CONTEXT

Background: Social disparities in housing conditions and environmental exposures have increasingly been recognized as major contributing factor for health inequalities. Aim: To simultaneously assess the impact of individual and neighbourhood socioeconomic factors on children’s environmental quality. Methods: Data on perceived exposures to air pollution and noise, impairment due to lack of access to green space, and socioeconomic position were collected by self-administered questionnaires during three consecutive cross-sectional surveys 2004-2007 in the city of Munich, Germany. In total, the study population comprised 3700 children aged 5-6 years living in 19 school districts. Data on neighbourhood socioeconomic factors of the resident population of these school districts were obtained from Munich’s statistical office. Adverse environmental quality was defined as parental report of at least 2 out of the 3 items moderate to very strong impairment due to air pollution, noise, or lack of access to green space in the residential environment. Multilevel analysis was applied to analyse the association of individual (level 1) and neighbourhood socioeconomic factors (level 2) with adverse environmental quality. Results: Bivariate analyses yielded significant relations between individual indicators of low socioeconomic position (parental unemployment, low household income, low parental education, single-parent family, foreign nationality) as well as contextual socioeconomic characteristics of socially disadvantaged residents (high percentage of low-income households, low education) and adverse environmental quality. In multilevel analyses, among the individual indicators only household income was associated with children’s adverse environmental quality (low income: OR 1.71, 95% CI 1.23-2.39). Even controlled for the individual characteristics high percentages of low income households in the neighbourhood (OR 2.50, 95% CI 1.24-5.05) and of single parent families (OR 0.39, 95% CI 0.19-0.78) were related to adverse environmental quality. Conclusions: Parent’s perceived adverse residential environmental quality of children is associated with small-area socioeconomic characteristics of the residential population independently of individual socioeconomic position.

Exploring school oral health outcomes and neighbourhood factors in schools participating in Ontario's "Healthy Schools" recognition program.

This ecologic study compared school-level oral health outcomes in schools participating in Ontario's "Healthy Schools" program and nonparticipating schools in York Region, Ontario in 2007-2008 and examined the effect of neighbourhood socio-economic factors. School-aggregated data were obtained for all 243 elementary schools. York Region Public Health Unit provided oral health data from school dental screenings. We obtained information about schools participating in the Ontario's "Healthy Schools" program from publicly accessible websites. Neighbourhood socio-economic data based on school postcodes were extracted from Statistics Canada (2006) census databases. School oral health outcomes included the percentage of children in each school requiring preventive care, non-urgent dental treatment, urgent dental treatment and children with > or = two decayed teeth. One hundred and six elementary schools (42%) participated in Ontario's "Healthy Schools" program in 2007-2008. Schools participating in the "Healthy Schools" program had a significantly lower percentage of children with > or = two decayed teeth (p < 0.001) and children requiring urgent dental treatment (p = 0.004) than non-participating schools. School participation/neighbourhood socio-economic factors interactions showed that a significantly lower percentage of children in low-income "Healthy Schools" had preventive and urgent dental treatment needs and > or = two decayed teeth than in low-income non-participating schools (p < 0.001). Schools participating in Ontario's "Healthy Schools" program had better school oral health outcomes than non-participating schools. School neighbourhood socio-economic factors affected school oral health outcomes, which could suggest that schools situated in poorer neighbourhoods may benefit more from health promotion activities than schools situated in more affluent neighbourhoods.

Ambient air pollution exposure and full-term birth weight in California

BackgroundStudies have identified relationships between air pollution and birth weight, but have been inconsistent in identifying individual pollutants inversely associated with birth weight or elucidating susceptibility of the fetus by trimester of exposure. We examined effects of prenatal ambient pollution exposure on average birth weight and risk of low birth weight in full-term births.MethodsWe estimated average ambient air pollutant concentrations throughout pregnancy in the neighborhoods of women who delivered term singleton live births between 1996 and 2006 in California. We adjusted effect estimates of air pollutants on birth weight for infant characteristics, maternal characteristics, neighborhood socioeconomic factors, and year and season of birth.Results3,545,177 singleton births had monitoring for at least one air pollutant within a 10 km radius of the tract or ZIP Code of the mother's residence. In multivariate models, pollutants were associated with decreased birth weight; -5.4 grams (95% confidence interval -6.8 g, -4.1 g) per ppm carbon monoxide, -9.0 g (-9.6 g, -8.4 g) per pphm nitrogen dioxide, -5.7 g (-6.6 g, -4.9 g) per pphm ozone, -7.7 g (-7.9 g, -6.6 g) per 10 μg/m3 particulate matter under 10 μm, -12.8 g (-14.3 g, -11.3 g) per 10 μg/m3 particulate matter under 2.5 μm, and -9.3 g (-10.7 g, -7.9 g) per 10 μg/m3 of coarse particulate matter. With the exception of carbon monoxide, estimates were largely unchanged after controlling for co-pollutants. Effect estimates for the third trimester largely reflect the results seen from full pregnancy exposure estimates; greater variation in results is seen in effect estimates specific to the first and second trimesters.ConclusionsThis study indicates that maternal exposure to ambient air pollution results in modestly lower infant birth weight. A small decline in birth weight is unlikely to have clinical relevance for individual infants, and there is debate about whether a small shift in the population distribution of birth weight has broader health implications. However, the ubiquity of air pollution exposures, the responsiveness of pollutant levels to regulation, and the fact that the highest pollution levels in California are lower than those regularly experienced in other countries suggest that precautionary efforts to reduce pollutants may be beneficial for infant health from a population perspective.

Broadening Our Understanding of Survival After Myocardial Infarction

As clinicians and scientists, it is common to presume that clinical outcomes after myocardial infarction (MI) are most profoundly influenced by the pathogenesis of the disease itself, including genetics, cardiovascular risk factors, inflammatory state, disease severity (eg, the number and severity of obstructed coronary arteries), and the treatments that we offer. Consequently, our efforts to optimize the outcomes of our patients are aimed at following clinical guidelines in care for individual patients.1–3 When our profession seeks to influence systems of care and public policy, our focus has been on increasing access to lifesaving therapies.4 Because they appear outside of physicians’ locus of control, risk factors related to patients’ socioeconomic status are often not considered targets for intervention. Article see p 375 Although numerous studies have defined an adverse association between lower socioeconomic status and post-MI treatment5 and outcomes,6–8 little work has been done to develop interventions to overcome these disparities. We also have not sought to systematically understand mediating factors that may influence the prognostic associations of socioeconomic risk factors with outcomes. The reasons there have been such little progress in overcoming socioeconomic status barriers, despite the national priorities to create equity in health care,9–11 are multifactorial and include both the difficulties in measuring socioeconomic status and the challenges in overcoming them. In a critical review of the science linking socioeconomic status to health outcomes, Braveman and colleagues12 demonstrated that different measures of socioeconomic status are not interchangeable, …

Neighborhood-level Confounding in Epidemiologic Studies

In early contextual studies, the aim was to demonstrate overall neighborhood influences rather than dissecting such influences into their components. Researchers did not need to worry about neighborhood-level confounding. However, as our interest shifts to the exploration of specific environmental effects, failure to consider neighborhood-level confounding may result in severely biased associations. We argue that neighborhood socioeconomic position and similar area structural factors may constitute powerful sources of confounding in studies of specific environmental factors and health. Controlling for neighborhood socioeconomic position is a convenient (but imperfect) adjustment strategy. Such control entails a minimal risk of overadjustment, but conveys a non-negligible risk of collider bias. Balancing the advantages and disadvantages, we suggest that researchers should often provide complementary analyses controlling for neighborhood socioeconomic position in studies of associations between specific environmental factors and health. Researchers should provide DAG-based descriptions of plausible scenarios to explore whether any decrease in the association of interest after adjustment for neighborhood socioeconomic position is likely due to neighborhood-level confounding, indirect pathway biases, or collider bias.

Neighborhood Deprivation, Individual Socioeconomic Status, and Frailty in Older Adults

To assess how individual socioeconomic status and neighborhood deprivation affect frailty. Nationally representative population-based study, the English Longitudinal Study of Aging (ELSA), analyzed cross-sectionally. Four thousand eight hundred eighteen individuals aged 65 and older. Outcome was a frailty index (FI), based on 58 potential deficits, with a theoretical range from 0 to 1; exposures were individual wealth and neighborhood deprivation (lack of local resources, financial and otherwise), based on a set of standard indicators. The FI score varied independently according to wealth and neighborhood deprivation. The mean FI score for an individual in the highest 20% of wealth and least deprived 20% of neighborhoods was 0.09 (95% confidence interval (CI)=0.09-0.09) and for an individual in the lowest 20% of wealth and most deprived 20% of neighborhoods was 0.17 (95% CI=0.16-0.17). Frailty in older adults is independently associated with individual and neighborhood socioeconomic factors. Older adults who are poor and live in deprived neighborhoods are most vulnerable. Policies and interventions intended to prevent or reduce frailty must take into account individual circumstances and the broader social settings in which individuals are located.

Neighborhood of Residence is Associated with Daily Adherence to CPAP Therapy

Adherence to continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea is poor. Risk factors for nonadherence are not well understood but may reflect individual or neighborhood socioeconomic factors. We sought to determine the association of socioeconomic status and initial CPAP adherence. Retrospective cohort study, 2005 to 2006. Philadelphia VA Medical Center. Of 330 consecutive veterans who met study criteria for initiation of CPAP therapy for newly diagnosed sleep apnea, 266 had complete data for study inclusion. N/A. Through a multivariable logistic regression model, using an outcome of objectively measured CPAP use - 4 h daily during the first week of treatment, we tested whether patients from higher socioeconomic neighborhoods had higher CPAP adherence. We measured neighborhood socioeconomic status with an index derived from the 2000 U.S. Census at the block group-level composed of median household income, male and female employment, adult high school completion, married households, and minority composition. CPAP adherence > 4 h occurred on 48.9% of 1,805 patient-days observed for the 266 subjects. After adjustment for individual sociodemographic characteristics and medical comorbidity, the probability of daily CPAP use 4 h ranged from 34.1% (95% CI, 26.4-42.7) for subjects from a low socioeconomic neighborhood (5th percentile) to 62.3% (95% CI, 53.8-70.1) for subjects from a high (95th percentile) neighborhood. In a retrospective cohort of veterans, initial CPAP adherence was closely associated with higher neighborhood socioeconomic factors. Future investigation should target specific impediments to adherence in the home and neighborhood environment.

A longitudinal examination of neighborhood socioeconomic factors and chronic pain outcomes

A longitudinal examination of neighborhood socioeconomic factors and chronic pain outcomes

Daily Functioning and Quality of Life in Children With Sickle Cell Disease Pain: Relationship With Family and Neighborhood Socioeconomic Distress

The aim of this study was to examine the relationship between individual/family and neighborhood socioeconomic distress, pain, and functional outcomes in children with sickle cell disease (SCD). We hypothesized that both individual economic distress as well as residence in neighborhoods of severe economic distress would predict children's level of pain-related functional disability and health-related quality of life (HRQOL). Participants (mean age, 12.14 years; 57% male, n = 56) were recruited from an outpatient hematology clinic at a Midwestern tertiary referral hospital. Questionnaires assessing pain, depression, functional disability, and HRQOL were completed by children and their caregivers. Individual socioeconomic data including parental education and family income were reported by caregivers. Neighborhood socioeconomic distress was identified using publicly available census tract data and was based on neighborhood poverty, female head of household, male unemployment, and high school dropout levels. Multivariate regression analyses revealed that individual/family socioeconomic distress was a significant predictor of children's functional disability and physical and psychosocial HRQOL. Neighborhood socioeconomic distress emerged as a significant independent predictor of physical HRQOL only, where living in a distressed neighborhood predicted diminished physical HRQOL. Findings suggest that individual socioeconomic status and neighborhood economic distress play similar but independent roles in predicting children's functional outcomes related to SCD pain. Little is known about the influence of either individual/family or neighborhood socioeconomic factors on pain and functioning in children with SCD. Our findings suggest that socioeconomic distress defined at both the individual level and at the neighborhood/community level are significant independent predictors of pain-related disability and HRQOL in children with SCD.

Neighborhood Socioeconomic and Social Factors and School Achievement in Boys and Girls

Previous work has shown that school achievement is lower in children living in poor neighborhoods. In this study, the authors hypothesized a role of neighborhood social capital. Data on 11-year-olds were obtained from the baseline measurements of a family cohort study ( n = 328). The data had a cross-level structure: neighborhood level, school level, and individual level. After including individual-level confounders, neighborhood socioeconomic disadvantage and social cohesion were not associated with school achievement in boys or girls. However, lower levels of neighborhood informal social control were associated with lower school achievement scores in boys only. In boys, a wider social environment that contributes to obedience to norms and values may be conducive to superior educational achievement.

The role of context: neighbourhood characteristics strongly influence HIV risk in young women in Ndola, Zambia

To examine the effect of neighbourhood socioeconomic factors on human immunodeficiency virus (HIV) prevalence in young women (aged 15-24 years) in Zambia. Re-analysis of a cross-sectional, population-based sero-survey of nearly 2000 adults conducted in 1997/1998 in Ndola, Zambia. Neighbourhood-level socioeconomic status (SES) was defined using the availability of running water and electricity in addition to educational, employment and occupational characteristics of adults older than 24 years. Neighbourhood-level and individual-level risk factors were analysed with a multivariate multilevel logistic regression model using a hierarchical conceptual framework. Young women living in neighbourhoods of lower or middle SES had higher HIV prevalences than those from higher SES neighbourhoods [lower SES: adjusted odds ratio (OR) 2.4, 95% confidence interval (CI) 1.3-4.5, middle SES: adjusted OR 2.4, 95% CI 1.3-4.7]. Young women living near a market were at increased risk of HIV infection (OR 2.9, 95% CI 1.4-5.9), while proximity to a health centre seemed protective (OR 0.4, 95% CI 0.2-1.0). When controlling for neighbourhood factors, better education was a risk factor for HIV infection (OR 1.5, 95% CI 1.0-2.1), although it was not significant in individual-level analysis. Community-level factors are as important as individual-level factors in determining HIV infection in young women. Confining analyses to individual-level factors ignores the underlying causes and the modifying effect of context on individual behaviour and may even lead to different conclusions concerning the role of individual-level factors.

Body Mass Index and Childhood Asthma: A Linear Association?

Our objective was to characterize the association between body mass index (BMI) and childhood asthma while adjusting for individual and neighborhood socioeconomic factors. Data were obtained from 3,804 students 10 to 11 years of age in Nova Scotia, Canada. Asthma was defined as parent-reported doctor-diagnosed asthma or bronchitis. Smoothed curves suggested a linear association between BMI and asthma with a 6 % increase in prevalence per unit increase of BMI. This association was independent of allergies, sex, and socioeconomic factors. Girls from socioeconomically disadvantaged neighborhoods were less likely to be asthmatic as were boys from well-educated and wealthy families.

A Multilevel Study of Socioeconomic Predictors of Regular Mammography Use Among African-American Women

Little is known about the predictors of adherence to mammography guidelines by African-American women. We assessed individual-level and group-level socioeconomic predictors of regular mammography use in a large cohort of African-American women. We included 14,706 participants in the Black Women's Health Study who were 40 to 69 years of age at baseline in 1995. Data were obtained through mail questionnaires at entry and biennially during three 2-year follow-up periods until 2001. We linked the women's addresses to census block (neighborhood) socioeconomic data. With multilevel multivariable regression analysis, we assessed the relation of individual-level and neighborhood socioeconomic factors to "regular" mammography use (use in all three follow-up periods) relative to nonregular use, with control for other predictors. Most participants had health insurance and almost half had graduated college. Having health insurance was the socioeconomic variable most strongly associated with regular mammography use (odds ratio, 3.59; 95% confidence interval 3.02-4.28); the association was present at all levels of educational attainment, household income, and neighborhood socioeconomic status. Regular mammography use increased with individual household income: odds ratio, 2.00 (95% confidence interval, 1.58-2.53) for household income > USD $100,000 relative to < USD $15,001. Regular mammography use did not vary across level of education. Higher neighborhood socioeconomic status was significantly associated with regular mammography use before, but not after, control for household income. Access to health insurance is strongly associated with regular mammography use among African-American women, even at higher levels of educational attainment and socioeconomic status. Neighborhood socioeconomic characteristics do not materially influence regular use.

Individual and neighborhood-level factors in predicting asthma.

To identify the neighborhood socioeconomic and housing factors at the census-block level and the sociodemographic factors at the individual level that are associated with the risk of asthma. Cross-sectional study of children aged between 5 and 18 years seen in a network of urban primary care clinics. A network of urban primary care clinics (Indiana University Medical Group) in Marion County, Indiana, in the calendar year 2000. A total of 2544 subjects with 1541 black children (947 girls, 594 boys) and 1003 white children (568 girls, 435 boys). Whether a subject ever had asthma. The prevalence rate of ever having asthma was 21% with the lowest (14.6%) in white girls and the highest (27.4%) in black boys. None of the census-block characteristics were significant in predicting ever having asthma. The significant predictors for childhood asthma were age, race, sex, and body mass index. Boys who were overweight had 3.1 times higher odds and girls who were overweight had 1.8 times higher odds of having asthma than girls who were normal weight. There was a stronger association between asthma and being overweight in female subjects than in male subjects. Black children had 1.3-fold higher odds of ever having asthma than white children. The highest likelihood of having asthma is among boys who were young, black, and overweight and the lowest among girls who were older, white, and normal weight. Increased efforts at prevention, screening, and treatment may need to be directed at certain subpopulations such as children living in socially and physically at-risk families and neighborhoods.

Socioeconomic disadvantage and change in blood pressure associated with aging.

Few studies have examined how the longitudinal change in blood pressure associated with aging differs across social groups within industrialized countries. Data from the Atherosclerosis Risk In Communities Study were used to investigate differences in the incidence of hypertension and in aging-related changes in blood pressure by neighborhood and individual socioeconomic factors over a 9-year follow-up. Disadvantage in multiple socioeconomic dimensions was associated with the greatest risk of developing hypertension (age- and sex-adjusted hazard ratio [HR] and 95% CI: HR 1.95, 95% CI 1.38 to 2.75 in whites and HR 1.43, 95% CI 0.96 to 2.13 in blacks). Aging-related increases in systolic blood pressure were inversely associated with socioeconomic position in whites (mean [SEM] 5-year increase in systolic blood pressure 7 [0.7] mm Hg in the most disadvantaged category and 5.4 [0.4] mm Hg in the most advantaged category). In whites, low socioeconomic position was also associated with more rapid declines in diastolic blood pressure after 50 years of age. Socioeconomic differences in hypertension incidence and changes in systolic blood pressure were reduced after adjustment for baseline blood pressure. The change in blood pressure associated with aging varies by social groups within the United States.