Individual/Neighborhood Social Factors and Blood Pressure in the RECORD Cohort Study

Abstract

Abstract-Recent studies have started to suggest that, beyond effects of individual socioeconomic profiles, socioeconomic characteristics of residential neighborhoods are independently associated with blood pressure. However, mechanisms involved in these associations remain unknown. To distinguish between different mechanisms, we investigated whether specific risk factors of hypertension (physical inactivity, alcohol consumption, smoking, body mass index, waist circumference, and resting heart rate) intervene as mediators in the associations between individual or neighborhood socioeconomic characteristics and systolic blood pressure. We relied on data from the RECORD Cohort Study (Residential Environment and CORonary heart Disease) on 5941 participants recruited in [2007][2008], aged 30 to 79 years, residing in 1824 neighborhoods in the Paris metropolitan area. Systolic blood pressure increased independently and regularly with both decreasing individual education and decreasing residential neighborhood education. Body mass index/waist circumference and resting heart rate mediated an appreciable share of the associations between education and blood pressure and, adding validity to the finding, were the 2 most significant mediators for the effects of both individual education and neighborhood education. We found that 52% (95% CI: 25% to 79%) of the association between neighborhood education and blood pressure was mediated by body mass index/waist circumference and 20% (95% CI: 5% to 36%) by resting heart rate. Future research will have to clarify the exact mechanisms through which body weight and shape and resting heart rate intervene as mediators in the associations between individual/neighborhood education and blood pressure. Key Words: blood pressure Ⅲ socioeconomic factors Ⅲ residence characteristics Ⅲ social environment Ⅲ heart rate Ⅲ obesity C onsidering socioeconomic characteristics is useful both in the clinical setting to improve risk stratification of patients at risk of hypertension and, from a public health perspective, to identify population-level determinants of blood pressure when defining interventions. 1 Regardless of the aim, recent studies suggest that a better assessment of socioeconomic differences in blood pressure may be obtained by considering social circumstances both at the individual level and at the residential neighborhood level. [2][3][4][5] To date, fewer studies have quantified neighborhood socioeconomic influences on blood pressure than on behavioral risk factors of cardiovascular diseases (smoking and physical inactivity) or obesity. 6 As recently emphasized, 7 knowledge useful for public health action is identifying the different mechanisms underlying associations between individual/neighborhood socioeconomic characteristics and blood pressure (eg, through known risk factors of hypertension) on which it would be possible to intervene to address social disparities in blood pressure. 1,8 However, on the one hand, the very few studies that investigated intermediate mechanisms throu...

The Socioeconomics of Hypertension

“…That obesity emerged as a chief link between lower educational status and higher SBP ( Figure) in the study by Brummett et al 3 may not be surprising at first glance-the association of lower SES with higher BMI and higher SBP has been observed in other developed countries 1,4 and has been attributed to lack of knowledge regarding dietary choices, lack of access to healthy foods in lower SES areas, 5 poorer weight management skills, or differing social norms related to body size. 6 However, the findings of Brummett et al 3 are striking when one takes into account how young the American National Longitudinal Study of Adolescent Health sample was (all in their 20s and early 30s): the majority (Ͼ60%) of these young adults were prehypertensive (SBP Ͼ120 mm Hg) or overweight (BMI Ͼ25 kg/m 2 ), whereas Ͼ1 in 10 were hypertensive (SBP Ͼ140 mm Hg) and Ͼ1 in 3 obese (BMI Ͼ30 kg/m 2 ).…”

“…Although psychosocial factors were not directly measured in the current study, the "protective" effect of being married suggested a role for social support, and previous studies have shown that perceived stress and depression were significant mediators of the association between lower SES and increased SBP. 4 The significance of these findings lies in the potential for preventive interventions, such as promoting healthy stress coping skills and regular aerobic exercise.Taken together, it is tempting to oversimplify the association between SES and SBP as such: socially disadvantaged individuals face job and neighborhood stressors, which, coupled with lack of knowledge and limited resources, drive these individuals to low-cost, high-calorie fast food options, resulting in obesity, the metabolic syndrome, and hypertension; chronic ill health may then limit job opportunities, creating even more stress and perpetuating the vicious cycle. The association may not, however, be that straightforward for the following reasons.…”

“…Although psychosocial factors were not directly measured in the current study, the "protective" effect of being married suggested a role for social support, and previous studies have shown that perceived stress and depression were significant mediators of the association between lower SES and increased SBP. 4 The significance of these findings lies in the potential for preventive interventions, such as promoting healthy stress coping skills and regular aerobic exercise.…”

How Socioeconomic Disadvantages Get Under the Skin and into the Brain to Influence Health Development Across the Lifespan

“…Neighborhood SED is also associated with higher resting blood pressure among adults in many studies (Chaix et al 2010;Chaix et al 2008;Cozier et al 2007;Cubbin et al 2000;Diez-Roux et al 2000;Harburg et al 1973;McGrath et al 2006). Several other markers of sympathetic nervous system dysfunction have been found among adults exposed to SED.…”

Community Characteristics are Associated with Blood Pressure Levels in a Racially Integrated Community

“…[1][2][3] A constellation of factors likely contribute to hypertensive risk in these communities. As examples, better access to grocery stores or recreational facilities has been associated with lower average blood pressure levels in large studies.…”