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Multilevel and Spatial–Time Trend Analyses of the Prevalence of Hypertension in a Large Urban City in the USA

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Abstract

We aimed to test two hypotheses that (1) there were significant variations in the prevalence of hypertension (HBP) across neighborhoods in the city of Philadelphia and (2) these variations were significantly explained by the variations in the neighborhood physical and socioeconomic environment (PSE). We used data from the Southeastern Pennsylvania Household Health Surveys in 2002–2004 (study period 1, n = 8,567), and in 2008–2010 (period 2, n = 8,747). An index of neighborhood PSE was constructed using multiple specific measures. The associations of HBP with PSE at the neighborhood level and other risk factors at the individual level were examined using multilevel regression analysis. The results show that age-adjusted prevalence of HBP increased from 30.33 to 33.04 % from study periods 1 to 2 (p < 0.001). An estimate of 44 and 53 % of the variations in the prevalence of HBP could be explained by the variations in neighborhood PSE in study periods 1 and 2, respectively. In conclusion, prevalence of HBP significantly increased from 2002–2004 to 2008–2010. Individuals living in neighborhoods with disadvantaged PSE have significantly higher risk of the prevalence of HBP.

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Acknowledgments

L Liu and AE Núñez are partly supported by the US DHHS Office of Women’s Health and Office of Public Health and Service-funded Philadelphia Ujima Study (Mind Spirit Body Health Collaborative, PI: AE Núñez). Grant number 5 CCEWH111020-02-00. The study used data from the Public Health Management Corporation (PHMC) Philadelphia. The responsibility for the analysis and interpretation of these data is solely that of the authors. The opinions expressed in this paper are those of the authors and do not represent the views of PHMC. Our thanks also go to Miss Michelle Klawans and Ms. Deirdre Potter for their careful proofreading of the report.

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, Drexel University School of Public Health, 1505 Race Street, Philadelphia, PA, 19102, USA

    Longjian Liu

  2. Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA

    Ana E. Núñez & Howard J. Eisen

  3. School of Public Health, Chengdu Medical College, Chengdu, Sichuan, China

    Xiaoping Yu

  4. Department of Medicine, the University of Pennsylvania, Philadelphia, PA, USA

    Xiaoyan Yin

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  1. Longjian Liu
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  2. Ana E. Núñez
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  3. Xiaoping Yu
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  4. Xiaoyan Yin
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  5. Howard J. Eisen
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Correspondence to Longjian Liu.

Appendix

Appendix

PSE-related questions

  1. 1.

    In the past year, how often did you use public recreation facilities in your neighborhood, such as public swimming pools, parks, schools, walking trails, bike paths, or recreation centers? (1 = more than once a week, 2 = once a week, 3 = a few times a month, 4 = once a month, 5 = less than once a month, 6 = never, 7 = there are no public recreation facilities in my neighborhood).

  2. 2.

    How easy or difficult is it for you to find fruits and vegetables in your neighborhood? Would you say that is very easy, easy, difficult, or very difficult (score 1–4)?

  3. 3.

    How would you rate the overall quality of groceries available in the stores in your neighborhood? Would you say it is excellent, good, fair, or poor (score 1–4)?

  4. 4.

    Using the following scale, please rate how likely people in your neighborhood are willing to help their neighbors with routine activities such as picking up their trash cans, or helping to shovel snow. Would you say that most people in your neighborhood are always, often, sometimes, rarely, or never willing to help their neighbors (score 1–5)?

  5. 5.

    Have people in your neighborhood ever worked together to improve the neighborhood (for example, through a neighborhood watch, creating a community garden, building a community playground, or participating in a block party, 1 = yes, 2 = no)?

  6. 6.

    Please tell me if you strongly agree, agree, disagree, or strongly disagree with the following statement: I feel that I belong and am a part of my neighborhood (score 1–4).

  7. 7.

    Please tell me if you strongly agree, agree, disagree, or strongly disagree with the following statement: Most people in my neighborhood can be trusted (score 1 – 4).

  8. 8.

    Household poverty level: 0 = not poor, at or above 150 % of federal poverty level, 1 = poor, below 150 % of federal poverty level.

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Liu, L., Núñez, A.E., Yu, X. et al. Multilevel and Spatial–Time Trend Analyses of the Prevalence of Hypertension in a Large Urban City in the USA. J Urban Health 90, 1053–1063 (2013). https://doi.org/10.1007/s11524-013-9815-x

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  • DOI: https://doi.org/10.1007/s11524-013-9815-x

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