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

  • Helen ColeEmail author
  • Dustin T. Duncan
  • Gbenga Ogedegbe
  • Samantha Bennett
  • Joseph Ravenell



Neighborhood-level poverty and racial composition may contribute to racial disparities in hypertension outcomes. Little is known about how the effects of neighborhood social environments may differ by nativity status among diverse urban Black adults. We aimed to characterize the influence of neighborhood-level socio-demographic factors on hypertension outcomes among US- and foreign-born Black men with uncontrolled blood pressure.


We conducted a cross-sectional analysis of baseline data from two large community-based trials of hypertensive Black men aged 50 and over linked with census tract data from the 2012 American Community Survey 5-year estimates. We defined census tracts with high racial segregation as those where 60 % or more self-identified as Black and high-poverty census tracts as those where 20 % or more lived below the poverty line. Multivariable general estimating equation models were used to measure associations between neighborhood characteristics and stage of hypertension, hypertension awareness, and treatment to yield adjusted prevalence ratios (aPR). Models were run separately for US- and foreign-born Black men.


Over 64 % of the 1139 participants lived in a census tract with a high percentage of Black residents and over 71 % lived in high-poverty census tracts. Foreign-born Black men living in neighborhoods with a high concentration of Black residents were less likely to be treated for their high blood pressure (aPR 0.44, 95 % CI 0.22–0.88), but this result did not hold for US-born Black men. There were no significant associations between neighborhood poverty and hypertension outcomes.


Neighborhood context may impact treatment for hypertension, one of the most important factors in hypertension control and decreasing hypertension-related mortality, particularly among foreign-born Black men.


Neighborhood context Black men Hypertension Health disparities 



We thank the participants of the study and the NYU Center for Healthful Behavior Change Men’s Health Initiative research staff that contributed to the project. The parent study was funded by the National Institutes of Health (NHLBI Grant # 5R01HL096946-05, Dr. Joseph Ravenell, Principal Investigator), the Comprehensive Center of Excellence in Disparities Research and Community Engagement (NCMHD grant # 5P60MD003421), and the Centers for Disease Control and Prevention, Prevention Research Centers Program (U48DP002671). We thank Jeff Blossom for geocoding the participants’ addresses and calculating neighborhood-level measures in ArcGIS. At the time this article was written, the corresponding author was with the Center for Healthful Behavior Change, Department of Population Health, NYU School of Medicine.

Compliance with Ethical Standards

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. 1.
    Kochanek KD, Arias E, Anderson RN. How did cause of death contribute to racial differences in life expectancy in the United States in 2010? NCHS Data Brief. 2013(125):1–8.Google Scholar
  2. 2.
    Wong MD, Shapiro MF, Boscardin WJ, Ettner SL. Contribution of major diseases to disparities in mortality. N Engl J Med. 2002;347(20):1585–92.CrossRefPubMedGoogle Scholar
  3. 3.
    Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, et al. Heart disease and stroke statistics—2012 update: a report from the American Heart Association. Circulation. 2012;125(1):e2–e220.CrossRefPubMedGoogle Scholar
  4. 4.
    Guo F, He D, Zhang W, Walton RG. Trends in prevalence, awareness, management, and control of hypertension among United States adults, 1999 to 2010. J Am Coll Cardiol. 2012;60(7):599–606.CrossRefPubMedGoogle Scholar
  5. 5.
    Jones DJ, Crump AD, Lloyd JJ. Health disparities in boys and men of color. Am J Public Health. 2012;102(Suppl 2):S170–2.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Williams DR. The health of men: structured inequalities and opportunities. Am J Public Health. 2008;98(9 Suppl):S150–7.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Gilbert KL, Ray R, Siddiqi A, Shetty S, Baker EA, Elder K, Griffith DM. Visible and invisible trends in black men’s health: pitfalls and promises for addressing racial, ethnic, and gender inequities in health. Annu Rev Public Health. 2016;37:295–311.CrossRefPubMedGoogle Scholar
  8. 8.
    Schulz AJ, Williams DR, Israel BA, Lempert LB. Racial and spatial relations as fundamental determinants of health in Detroit. Milbank Q. 2002;80(4):677.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Gilbert KL, Elder K, Lyons S, Kaphingst K, Blanchard M, Goodman M. Racial composition over the life course: examining separate and unequal environments and the risk for heart disease for African American men. Ethn Dis. 2015;25(3):295–304.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Buys DR, Howard VJ, McClure LA, Buys KC, Sawyer P, Allman RM, Levitan EB. Association between neighborhood disadvantage and hypertension prevalence, awareness, treatment, and control in older adults: results from the University of Alabama at Birmingham Study of Aging. Am J Public Health. 2015;105(6):1181–8.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Coulon SM, Wilson DK, Alia KA, Van Horn ML. Multilevel associations of neighborhood poverty, crime, and satisfaction with blood pressure in African-American adults. Am J Hypertens 2015.Google Scholar
  12. 12.
    Vanasse A, Courteau J, Asghari S, Leroux D, Cloutier L. Health inequalities associated with neighbourhood deprivation in the Quebec population with hypertension in primary prevention of cardiovascular disease. Chronic Dis Inj Can. 2014;34(4):181–94.PubMedGoogle Scholar
  13. 13.
    Kershaw KN, Diez Roux AV, Burgard SA, Lisabeth LD, Mujahid MS, Schulz AJ. Metropolitan-level racial residential segregation and black-white disparities in hypertension. Am J Epidemiol. 2011;174(5):537–45.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Morenoff JD, House JS, Hansen BB, Williams DR, Kaplan GA, Hunte HE. Understanding social disparities in hypertension prevalence, awareness, treatment, and control: the role of neighborhood context. Soc Sci Med. 2007;65(9):1853–66.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Yi S, Elfassy T, Gupta L, Myers C, Kerker B. Nativity, language spoken at home, length of time in the United States, and race/ethnicity: associations with self-reported hypertension. Am J Hypertens. 2014;27(2):237–44.CrossRefPubMedGoogle Scholar
  16. 16.
    Griffith DM, Johnson JL, Zhang R, Neighbors HW, Jackson JS. Ethnicity, nativity, and the health of American Blacks. J Health Care Poor Underserved. 2011;22(1):142–56.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Doamekpor LA, Dinwiddie GY. Allostatic load in foreign-born and US-born blacks: evidence from the 2001–2010 National Health and Nutrition Examination Survey. Am J Public Health. 2015;105(3):591–7.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Capps R, McCabe K, Fix M. New streams: Black African migration to the United States. In: Washington, DC: Migration Policy Institute; 2011.Google Scholar
  19. 19.
    Kent MM. Immigration and America’s Black population. In: Population Reference Bureau; 2007.Google Scholar
  20. 20.
    Ludwig B, Reed H. “When you are here, you have high blood pressure”: Liberian refugees’ health and access to healthcare in Staten Island, NY. International Journal of Migration Health and Social Care. 2016;12(1):26–37.CrossRefGoogle Scholar
  21. 21.
    White K, Borrell LN, Wong DW, Galea S, Ogedegbe G, Glymour MM. Racial/ethnic residential segregation and self-reported hypertension among US- and foreign-born blacks in New York City. Am J Hypertens. 2011;24(8):904–10.CrossRefPubMedGoogle Scholar
  22. 22.
    Ravenell J, Thompson H, Cole H, Plumhoff J, Cobb G, Afolabi L, Boutin-Foster C, Wells M, Scott M, Ogedegbe G. A novel community-based study to address disparities in hypertension and colorectal cancer: a study protocol for a randomized control trial. Trials. 2013;14:287.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Duncan DT, Kawachi I, White K, Williams DR. The geography of recreational open space: influence of neighborhood racial composition and neighborhood poverty. Journal of Urban Health-Bulletin of the New York Academy of Medicine. 2013;90(4):618–31.PubMedGoogle Scholar
  24. 24.
    Subramanian SV, Chen JT, Rehkopf DH, Waterman PD, Krieger N. Comparing individual- and area-based socioeconomic measures for the surveillance of health disparities: a multilevel analysis of Massachusetts births, 1989–1991. Am J Epidemiol. 2006;164(9):823–34.CrossRefPubMedGoogle Scholar
  25. 25.
    Subramanian SV, Chen JT, Rehkopf DH, Waterman PD, Krieger N. Racial disparities in context: a multilevel analysis of neighborhood variations in poverty and excess mortality among black populations in Massachusetts. Am J Public Health. 2005;95(2):260–5.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Krieger N, Chen JT, Waterman PD, Rehkopf DH, Subramanian SV. Race/ethnicity, gender, and monitoring socioeconomic gradients in health: a comparison of area-based socioeconomic measures—the public health disparities geocoding project. Am J Public Health. 2003;93(10):1655–71.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Krieger N, Chen JT, Waterman PD, Soobader MJ, Subramanian SV, Carson R. Geocoding and monitoring of US socioeconomic inequalities in mortality and cancer incidence: does the choice of area-based measure and geographic level matter?: the Public Health Disparities Geocoding Project. Am J Epidemiol. 2002;156(5):471–82.CrossRefPubMedGoogle Scholar
  28. 28.
    Duncan DT, Aldstadt J, Whalen J, White K, Castro MC, Williams DR. Space, race, and poverty: spatial inequalities in walkable neighborhood amenities? Demogr Res. 2012;26:409–48.CrossRefGoogle Scholar
  29. 29.
    Franzini L, Taylor W, Elliott MN, Cuccaro P, Tortolero SR, Janice Gilliland M, Grunbaum J, Schuster MA. Neighborhood characteristics favorable to outdoor physical activity: disparities by socioeconomic and racial/ethnic composition. Health Place. 2010;16(2):267–74.CrossRefPubMedGoogle Scholar
  30. 30.
    Kelly CM, Schootman M, Baker EA, Barnidge EK, Lemes A. The association of sidewalk walkability and physical disorder with area-level race and poverty. J Epidemiol Community Health. 2007;61(11):978–83.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo Jr JL, Jones DW, Materson BJ, Oparil S, Wright Jr JT, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42(6):1206–52.CrossRefPubMedGoogle Scholar
  32. 32.
    Pierannunzi C, SS H, Balluz L. A systematic review of publications assessing reliability and validity of the Behavioral Risk Factor Surveillance System (BRFSS), 2004–2011. BMC Med Res Methodol. 2013;13:49.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Hirsch JA, Moore KA, Evenson KR, Rodriguez DA, Diez Roux AV. Walk Score® and Transit Score® and walking in the Multi-Ethnic Study of Atherosclerosis. Am J Prev Med. 2013;45(2):158–66.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Spiegelman D, Hertzmark E. Easy SAS calculations for risk or prevalence ratios and differences. Am J Epidemiol. 2005;162(3):199–200.CrossRefPubMedGoogle Scholar
  35. 35.
    McNutt LA, Wu C, Xue X, Hafner JP. Estimating the relative risk in cohort studies and clinical trials of common outcomes. Am J Epidemiol. 2003;157(10):940–3.CrossRefPubMedGoogle Scholar
  36. 36.
    Behrens T, Taeger D, Wellmann J, Keil U. Different methods to calculate effect estimates in cross-sectional studies. A comparison between prevalence odds ratio and prevalence ratio. Methods Inf Med. 2004;43(5):505–9.PubMedGoogle Scholar
  37. 37.
    Mensah GA, Dunbar SB. A framework for addressing disparities in cardiovascular health. J Cardiovasc Nurs. 2006;21(6):451–6.CrossRefPubMedGoogle Scholar
  38. 38.
    Osypuk TL, Diez Roux AV, Hadley C, Kandula NR. Are immigrant enclaves healthy places to live? The Multi-ethnic Study of Atherosclerosis. Soc Sci Med. 2009;69(1):110–20.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Greer CM. Black ethnics: race, immigration, and the pursuit of the American dream. New York, NY: Oxford University Press; 2013.CrossRefGoogle Scholar
  40. 40.
    Smedley AY, Nelson AR. Unequal treatment: confronting racial and ethnic disparities in health care. In: Washington, D.C.: Institute of Medicine of the National Academies; 2003.Google Scholar
  41. 41.
    Landrine H, Corral I. Separate and unequal: residential segregation and black health disparities. Ethnicity & Disease. 2009;19(2):179–84.Google Scholar
  42. 42.
    Griffith DM, Neighbors HW, Johnson J. Using national data sets to improve the health and mental health of Black Americans: challenges and opportunities. Cultur Divers Ethnic Minor Psychol. 2009;15(1):86–95.CrossRefPubMedGoogle Scholar
  43. 43.
    Murthy VH, Krumholz HM, Gross CP. Participation in cancer clinical trials: race-, sex-, and age-based disparities. JAMA. 2004;291(22):2720–6.CrossRefPubMedGoogle Scholar
  44. 44.
    Duncan DT, Kapadia F, Halkitis PN. Examination of spatial polygamy among young gay, bisexual, and other men who have sex with men in New York City: the P18 cohort study. Int J Environ Res Public Health. 2014;11(9):8962–83.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Duncan DT, Regan SD, Shelley D, Day K, Ruff RR, Al-Bayan M, Elbel B. Application of global positioning system methods for the study of obesity and hypertension risk among low-income housing residents in New York City: a spatial feasibility study. Geospat Health. 2014;9(1):57–70.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Duncan DT, Kawachi I, Subramanian SV, Aldstadt J, Melly SJ, Williams DR. Examination of how neighborhood definition influences measurements of youths’ access to tobacco retailers: a methodological note on spatial misclassification. Am J Epidemiol. 2014;179(3):373–81.CrossRefPubMedGoogle Scholar

Copyright information

© W. Montague Cobb-NMA Health Institute 2016

Authors and Affiliations

  1. 1.Institut de Ciència i Tecnologia AmbientalsUniversitat Autònoma de BarcelonaBarcelonaSpain
  2. 2.Institut Hospital del Mar d’Investigacions MèdiquesBarcelonaSpain
  3. 3.Department of Population HealthNew York University School of MedicineNew YorkUSA
  4. 4.College of Global Public HealthNew York UniversityNew YorkUSA
  5. 5.Population CenterNew York UniversityNew YorkUSA

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