Racial Composition Over the Lifecourse: Examining Separate and Unequal Environments and the Risk for Heart Disease for African American Men

Abstract

Racial composition oveR the life couRse: examining sepaRate and unequal enviRonments and the Risk foR heaRt disease foR afRican ameRican men IntroductIonThe experiences of many African American (AA) men are associated with several health risk factors, poverty, distrust of institutions, discrimination, and isolation, which place them at greater risk for health problems. 1,2 AA men are plagued with health issues earlier in life, disproportionately suffer from preventable conditions, and suffer disproportionately higher mortality, compared with White men. 3,4 As overall mortality and morbidity has improved in the Unites States, AA men remain more likely to die from chronic diseases such as cardiovascular disease, diabetes, and cancers compared with their White counterparts. 5 As concerning, AA men have a life expectancy five years less than White men. 6 All of the aforementioned speak to a life course of disparities for AA men, with roots in the cumulative disadvantage perspective and the weathering hypothesis. 7-9 However, Thorpe and Kelley-Moore suggest health disparities that include a life course approach use more biological, psychosocial, and environmental measures across the life course, which also captures an ecological perspective. 8 There has been some exploration about the influence of the environment on racial differences in predisposition to hypertension and stroke, by examining different exposure time points and duration across the life course for AAs and Whites. AAs have a higher risk for developing hypertension and stroke when exposed to segregated environments earlier in life. 10 These factors are often unaccounted for in the study of AA men's health.Purpose: Studies have demonstrated the effects of segregated social and physical environments on the development of chronic diseases for African Americans. Studies have not delineated the effects of segregated environments specifically on the health of African American men over their lifetime. This study examines the relationship between life course measures of racial composition of social environments and diagnosis of hypertension among African American men. Design:We analyzed cross-sectional data from a convenience sample of African American men seeking health care services in an outpatient primary care clinic serving a medically underserved patient population (N=118). Multivariable logistic regression analyses were used to examine associations between racial composition of multiple environments across the life course (eg, junior high school, high school, neighborhood growing up, current neighborhood, place of employment, place of worship) and hypertension diagnosis. Results:The majority (86%) of participants were not currently in the workforce (retired, unemployed, or disabled) and more than half (54%) reported an annual household income of <$9,999; median age was 53. Results suggest that African American men who grew up in mostly Black neighborhoods (OR=4.3; P=.008), and worked in mostly Black environments (OR=3.1; P=.041) were more likely to be dia...

Visible and Invisible Trends in Black Men's Health: Pitfalls and Promises for Addressing Racial, Ethnic, and Gender Inequities in Health

“…A range of studies that draws on life-course theory has demonstrated both independent and combined influences of early (childhood) and late (adult) socioeconomic status on a variety of health outcomes (11, 28, 54). Given the potential importance of socioeconomic disadvantage in explaining health disadvantages among black men and women, it is somewhat surprising that more studies have not drawn on life-course theory to explain racial disparities in health (28, 75). In fact, a PubMed search for the terms “black,” “life course,” and “socioeconomic” produced only 26 studies.…”

Why Police Kill Black Males with Impunity: Applying Public Health Critical Race Praxis (PHCRP) to Address the Determinants of Policing Behaviors and “Justifiable” Homicides in the USA

“…Cardiovascular disease (CVD) becomes the leading cause of death for black males in their 40s. [13][14][15] The stress and psychological costs of trying to escape social discrimination may increase the likelihood of CVD and other deleterious health outcomes that contribute to black men's risk of an early death 16 -a classic determinant of John Henryism. 17 John Henryism suggests that black men experience chronic stressors shaped by poverty and discrimination.…”

Neighborhood Socioeconomic Disadvantage; Neighborhood Racial Composition; and Hypertension Stage, Awareness, and Treatment Among Hypertensive Black Men in New York City: Does Nativity Matter?

“…[5-7] In addition, due to political and economic macrosocial policies, Black men are more likely than others to live in highly segregated and high poverty neighborhoods. [7-9]…”

“…Thus, experiences during early childhood and adult exposures together lead to poor health outcomes, which become more evident with age. [6, 9] Furthermore, past studies have generally included samples of the general population, and have not honed in on those with uncontrolled blood pressure, who are most at risk for adverse blood pressure-related outcomes. Among Blacks, within-race diversity such as nativity is rarely acknowledged, despite an urban population which is over one quarter foreign-born.…”