Disparities in Cardiovascular Disease Risk: Neighborhood Segregation and Poverty

Johns Hopkins University, Baltimore MD

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Abstract

DESCRIPTION (provided by applicant): Despite declines in cardiovascular disease (CVD) over the past 30 years, CVD remains the leading cause of death for Americans and contributes substantially to morbidity and disability (US DHHS 2000). Significant disparities exist in the prevalence of disease and its risk factors by race and socio-economic position and improvements in risk factors over time has been uneven (US DHS 2000;Kanjilal 2006;Mensah 2005;Kurian 2007). While racial disparities in CVD are well documented, their etiology is not well understood and the confounding effects of socio-economic position and residential segregation are not adequately accounted for in the literature (LaVeist 2005;LaVeist et al. forthcoming). Both residential segregation and concentrated poverty have been posited to be fundamental social determinants of proximate factors that produce racial disparities in CVD (Kanjilal 2006;Mensah 2005). However, few studies have tested this proposition empirically (Acevedo-Garcia et al. 2003). In this study, we propose to use the National Health and Nutrition Examination Survey (NHANES) merged with census tract level data from the 2000 Census of Population and Housing Summary File 3. We will examine the association between CVD risk factors and both residential segregation and concentrated poverty and estimate the contribution of these factors to racial disparities. Clinical CVD risk factors to be examined will include: hypertension, diabetes, hyper-lipidemia, cardiovascular fitness, and obesity. Behavioral risk factors will include physical activity, smoking, alcohol use, nutrition, and screening practices. Finally, we will explore whether residential characteristics such as availability of food store outlets, health care providers, and walkability mediate the relationship between segregation, concentrated poverty and CVD risk factors. PUBLIC HEALTH RELEVANCE: This project will examine the social determinants of racial disparities in clinical and behavioral risk factors for cardiovascular disease. The project is designed to focus on the association between racial residential segregation and concentrated poverty on hypertension, diabetes, hyperlipidemia, cardiovascular fitness, and obesity and on physical activity, smoking, alcohol use, nutrition, and screening practices. In addition, the project will assess the extent to which racial residential segregation and concentrated poverty account for race disparities in these risk factors and what characteristics of such neighborhoods negatively impact cardiovascular health.