Neighborhood Socioeconomic Disadvantage; Neighborhood Racial Composition; and Hypertension Stage, Awareness, and Treatment Among Hypertensive Black Men in New York City: Does Nativity Matter?
- 240 Downloads
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.
KeywordsNeighborhood 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
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.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
- 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.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
- 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.Kent MM. Immigration and America’s Black population. In: Population Reference Bureau; 2007.Google Scholar
- 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
- 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.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
- 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
- 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.Landrine H, Corral I. Separate and unequal: residential segregation and black health disparities. Ethnicity & Disease. 2009;19(2):179–84.Google Scholar
- 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