Neighborhoods and Cumulative Biological Risk Profiles by Race/Ethnicity in a National Sample of U.S. Adults: NHANES III

Abstract

PURPOSE To examine race/ethnic specific patterns of association between neighborhood socioeconomic status (NSES) and a cumulative biological risk index in a nationally representative population. METHODS The study sample included 13,199 non-Hispanic white, non-Hispanic black and Mexican American men and women, ages 20 and older, who attended the National Health and Examination Survey examination 1988 and 1994. Neighborhoods were defined as census tracts and linked to US Census measures from 1990 and 2000, interpolated to the survey year; the NSES score included measures of income, education, poverty and unemployment and categorized into quintiles, with the highest indicating greater NSES. A summary biological risk score, allostatic load (AL; range 0-9), was created from nine biological indicators of elevated risk, including serum levels of C-reactive protein, albumin, glycated hemoglobin, total and HDL cholesterol, waist-to-hip ratio, systolic and diastolic blood pressure, and resting heart rate. Regression models stratified by race/ethnicity examined AL as a continuous and dichotomous (high (>=3) vs. low AL) outcome. RESULTS For both outcomes, we found strong inverse associations between NSES and AL for blacks, after adjusting for age, gender, US birth, urbanicity and individual SES. These associations were weaker and less consistent for Mexican Americans and whites. CONCLUSIONS Our results indicate that living in low NSES neighborhoods is most strongly associated with greater cumulative biological risk profiles in the black US population.

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