Changes in perceptions of neighborhood environment and Cardiometabolic outcomes in two predominantly African American neighborhoods

Abstract

Background: Perceived neighborhood characteristics, including satisfaction with one's neighborhood as a place to live, are associated with lower obesity rates and more favorable cardiovascular risk factor profiles. Yet, few studies have evaluated whether changes in perceived neighborhood characteristics over time may be associated with cardiometabolic health indicators. Methods: Changes in perception of one's neighborhood (2013)(2014)(2015)(2016) were determined from a cohort of residents who lived in one of two low-income urban neighborhoods. Changes were categorized into the following: improvement vs. no change or worsening over the three-year time-period. Multivariable linear regression was used to measure the association between perceived improvement in each of the neighborhood characteristics with cardiometabolic outcomes (BMI, SBP, DBP, HbA1c, HDL-c) that were assessed in 2016, and compared with those who perceived no change or worsening of neighborhood characteristics. Models were adjusted for age, sex, income, education, marital status, physical function, neighborhood, and years spent in neighborhood. To examine potential sex differences, follow-up models were conducted and stratified by sex. Results: Among the 622 individuals who remained in the same neighborhood during the time period, 93% were African American, 80% were female, and the mean age was 58 years. In covariate-adjusted models, those who perceived improvement in their neighborhood safety over the time period had a significantly higher BMI (kg/m 2 ) than those who perceived no improvement or worsening (β = 1.5, p = 0.0162); however, perceived improvement in safety was also significantly associated with lower SBP (mmHg) (β = − 3.8, p = 0.0361). When results were stratified by sex, the relationship between improved perceived neighborhood safety and BMI was only evident in females. Conclusions: These findings suggest that perceived neighborhood characteristics may impact cardiometabolic outcomes (BMI, SBP), but through differing pathways. This highlights the complexity of the associations between neighborhood characteristics and underscores the need for more longitudinal studies to confirm the associations with cardiometabolic health in African American populations.

Feelings of safety during daytime walking: associations with mental health, physical activity and cardiometabolic health in high vacancy, low-income neighborhoods in Detroit, Michigan

“…Unexpectedly, we also found a negative association between A1C and number of blighted lots. Echoing our unexpected findings, another study comprised primarily of African Americans found a positive association between A1C and perceived improvements in neighborhood safety among females only [ 101 ]. However, this relationship attenuated to non-significance after adjustment for baseline BMI.…”

“…BMI was also positively associated with lack of perceived safety in a majority Latino sample in Los Angeles [100]. In a recent study in a predominantly African American (93%) sample, the opposite was found [101]. Specifically, perceived improvements in neighborhood safety over a 3-year period were associated with significantly higher BMI, particularly among females, but not after adjustment for baseline BMI.…”

Social Determinants of Health and Diabetes: A Scientific Review

“…Supermarket gain in neighborhoods was associated with marginally better HbA 1c outcomes, but only for those with near-normal HbA 1c baseline values (223). In a natural experiment design, the Pittsburgh Hill/Homewood Study on Eating, Shopping, and Health (PHRESH) tested the effects of adding a supermarket, along with other neighborhood investments, on cardiometabolic risk factors among a randomly selected cohort of residents from two low-income, urban, and predominately African American matched neighborhoods (222,224). Results for the intervention neighborhood (receiving the supermarket) showed improved perceived access to healthy food (225), and the prevalence of diabetes increased less in the neighborhood with the supermarket than in the comparison neighborhood.…”

Evaluating the Relationship between Neighborhood-Level Social Vulnerability and Patient Adherence to Ophthalmology Appointments

“…31 Racial residential segregation affects how neighborhood investment decisions are made which has resulted in uneven access to health care 32, 33 and consequently, shorter life expectancies in highly segregated Black communities. 34, 35 Racial minorities are more likely to live in underserved areas with lower levels of health and social service opportunities, further perpetuating poor health outcomes. 36-39 The National Institute on Minority Health and Health Disparities (NIMHD) Research Framework describes a multidimensional model that depicts a comprehensive set of health determinants which includes domains of influence over the life course (biological, behavioral, physical/built environment, sociocultural environment, and the health care system) and levels of influence (individual, interpersonal, community, and societal).…”