1572-P: Neighborhood Investments and Cardiometabolic Health in Two Predominantly African-American Communities: A Natural Experiment Study

Abstract

Background: Neighborhood disadvantage is a robust and independent risk factor for poor cardiometabolic health, however, causal relationships have been difficult to establish. We used a natural experiment design to examine neighborhood investment on cardiometabolic risk factors among a randomly selected cohort of residents from two, low-income, urban, and predominately African American matched neighborhoods. Methods: The sample included 532 participants (80% female; mean age=59 years; mean income=$21,073). During the study period (2016-2018), the intervention neighborhood received substantially more publicly-funded investments (housing and commercial investment) than a demographically matched comparison neighborhood. Difference-in-difference analyses tested for differential change between the neighborhoods in BMI, HbA1c, HDL-c, and SBP and DBP. Covariates included age, sex, income, education, presence of children in the home, length of residence in neighborhood, and BMI (for all outcomes except BMI). Results: Contrary to expectations, relative to the comparison neighborhood, we saw a net increase in DBP (β=3.00, SE=1.24; p =.02) and a marginally significant increase in SBP (β= 4.30, p = .07) in the intervention neighborhood. In contrast, for HbA1c and HDL-c, intervention neighborhood residents showed improvements in these outcomes, relative to the comparison neighborhood; however, the effects were non or marginally significant after covariate adjustment (p=.12 for HbA1c and p=0.06 for HDL-c). There were no significant changes in BMI. Conclusion: Our findings suggest that the potential cardiometabolic benefits of neighborhood revitalization may manifest over a longer period of follow-up, and that there may be some interim consequences for certain health outcomes, in the process of neighborhood change. These findings highlight the importance of examining root causes of health disparities and using robust study designs. Disclosure T. Gary-Webb: None. T. Dubowitz: None. T.A. Bogart: None. M. Ghosh Dastidar: None. W.M. Troxel: None. Funding National Heart, Lung, and Blood Institute (HL131531)

Subsidised housing and diabetes mortality: a retrospective cohort study of 10 million low-income adults in Brazil

“…Since subsidised housing estates in Brazil are commonly located in socially disadvantaged areas, 36 37 39 41 which are a potential predictor of poor diabetes management, 1 2 contextual-level interventions may be warranted. Improvements in cardiometabolic health due to a contextual-level intervention were observed, for example, in the study by Gary-Webb et al , 53 which conducted a natural experiment to analyse the effect of neighbourhood investment on cardiometabolic risk factors among a randomly selected cohort of residents from two low-income and predominantly African-American matched neighbourhoods, in 2016–2018. The authors found that residents from the neighbourhood that received more publicly funded investments (housing and commercial investment) showed improvements in hemoglobin A1c and high-density lipoprotein cholesterol levels compared with residents from the neighbourhood that received less investment.…”

“…The authors found that residents from the neighbourhood that received more publicly funded investments (housing and commercial investment) showed improvements in hemoglobin A1c and high-density lipoprotein cholesterol levels compared with residents from the neighbourhood that received less investment. 53 …”