Neighborhood Disadvantage and Cumulative Biological Risk Among a Socioeconomically Diverse Sample of African American Adults: An Examination in the Jackson Heart Study

Abstract

Objectives Neighborhoods characterized by disadvantage influence multiple risk factors for chronic disease and are considered potential drivers of racial and ethnic health inequities in the United States. The objective of the present study was to examine the relationship between neighborhood disadvantage and cumulative biological risk (CBR) and the extent to which the association differs by individual income and education among a large, socio-economically diverse sample of African American adults. Methods Data from the baseline examination of the Jackson Heart Study (2000-2004) were used for the analyses. The sample consisted of African American adults ages 21-85 with complete, geocoded data on CBR biomarkers and behavioral covariates (n=4,410). Neighborhood disadvantage was measured using a composite score of socioeconomic indicators from the 2000 US Census. Eight biomarkers representing cardiovascular, metabolic, inflammatory, and neuroendocrine systems were used to create a CBR score. We fit two-level linear regression models with random intercepts and included cross-level interaction terms between neighborhood disadvantage and individual SES. Results Living in a disadvantaged neighborhood was associated with greater CBR after covariate adjustment (B=0.18, SE: 0.07, p<0.05). Interactions showed a weaker association for individuals with ≤ high school education, but were not statistically significant. Conclusion Disadvantaged neighborhoods contribute to poor health among African American adults via cumulative biological risk. Policies directly addressing the socioeconomic conditions of these environments should be considered as viable options to reduce disease risk in this group and mitigate racial/ethnic health inequities.

Neighborhood Socioeconomic Status in Relation to Serum Biomarkers in the Black Women’s Health Study

“…11 More recently, a cross-sectional analysis of data from the Jackson Heart Study found that cumulative biological risk, measured by biomarkers including CRP, hgA1C, and HDL, was directly associated with increased neighborhood disadvantage. 20 Moreover, while there was some degree of SES heterogeneity in the Jackson Heart Study, the overall household poverty rate of Jackson, MS, was 17.6 % compared to 11.3 % for the rest of the USA, and 73 % of the sample was classified as residing in the Bmost disadvantaged^neighborhoods. 20 The current analysis extends these findings in that the BWHS is a sample of black women with generally high levels of education and income.…”

“…20 Moreover, while there was some degree of SES heterogeneity in the Jackson Heart Study, the overall household poverty rate of Jackson, MS, was 17.6 % compared to 11.3 % for the rest of the USA, and 73 % of the sample was classified as residing in the Bmost disadvantaged^neighborhoods. 20 The current analysis extends these findings in that the BWHS is a sample of black women with generally high levels of education and income. Overall, 80 % of participants have completed education beyond high school, and 55 % report a household income of $50,000 or higher.…”

“…14,15 Black women at all levels of education are more likely to live in poor neighborhoods than are white women [16][17][18][19] ; thus, it is important to determine whether low neighborhood SES is associated with cardiovascular risk factors independent of individual-level SES. Previous studies of neighborhood SES and biomarkers that included black women were limited to low SES communities 5,20 and the elderly 21 or had too few subjects to allow for specific analyses of black women across SES. 14 A study of African-American adults living in Jackson, MS, found that neighborhood disadvantage was associated with higher cumulative biological risk.…”

“…14 A study of African-American adults living in Jackson, MS, found that neighborhood disadvantage was associated with higher cumulative biological risk. 20 One study which analyzed black women across SES found conflicting results. 8 In the present analyses, we examined the association of neighborhood SES with biomarkers of inflammation, metabolic disease, and CVD risk using data from the Black Women's Health Study (BWHS), a cohort study of US black women including large numbers of women at all levels of neighborhood and individual SES.…”

Social Justice, Social Determinants of Health, Interprofessional Practice and Community Engagement as Formative Elements of a Nurse Practitioner Managed Health Center

“…Individuals with low education and income are more likely than better-educated, higher-income individuals to lack a stable job, safe housing, food security and adequate income to meet health needs. Inequity in resources result in increased morbidity and mortality and these interactions have a cumulative effect over the life course for individuals, families and communities [10][11][12][13][14][15][16].…”