Cross-sectional relations of race and poverty status to cardiovascular risk factors in the Healthy Aging in Neighborhoods of Diversity across the Lifespan (HANDLS) study

Waldstein, Shari R.; Moody, Danielle L. Beatty; McNeely, Jessica M.; Allen, Amy N.; Sprung, Mollie R.; Shah, Mauli T.; Al-Najjar, Elias; Evans, Michele K.; Zonderman, Alan B.

doi:10.1186/s12889-016-2945-9

Cited by 16 publications

(14 citation statements)

References 31 publications

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“…Elevated health risk among those falling at the intersection of a high status (e.g., high SES) and low status social category (e.g., female sex) may represent what Bowleg (2012) refers to as an intersectionality paradox. These data reflect a pattern similar to the work showing diminishing returns for African Americans ascending the ranks of SES who experience poorer, not better, health (Diez-Roux, Nieto, Tyroler, Crum, & Szklo, 1995; Farmer & Ferraro, 2005; Waldstein et al, 2016). Diminishing returns is posited to be influenced by the price of economic progress for a minority group.…”

Section: Discussionsupporting

confidence: 81%

Interpersonal-level discrimination indices, sociodemographic factors, and telomere length in African-Americans and Whites

Moody

Leibel

Darden

et al. 2019

Biological Psychology

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Objective: Studies have linked self-reported discrimination to telomere attrition, a biological marker of accelerated cellular aging. However, it is unknown whether intersections between social categories—race, socioeconomic status (SES), sex, and age—influence the association of varying forms of discrimination with telomere length. We examined these associations in a socioeconomically and racially/ethnically diverse urban sample. Methods: Cross-sectional data were from 341 middle-aged (30–64 years) African American and White, community participants in the Healthy Aging in Neighborhoods of Diversity across the Life Span Study (HANDLS). Multiple regression models examined up to 3-way interactions between a discrimination measure (i.e., everyday, racial, gender, lifetime burden, and frequency of discrimination across sources) and two social categories. Results: After adjusting for depressive symptoms, waist circumference, and lifetime substance use, two themes emerged: 1) among women with higher SES, a) greater lifetime discrimination burden (b = −0.23, p = .011), gender discrimination (b = −0.29, p = .040), and racial discrimination (b = −0.24, p = 0.023) and 2) among younger adults, irrespective of race and sex, greater frequency of discrimination across sources (b = 0.002, p = .008) was associated with shorter telomeres. Conclusions: Irrespective of race, women with higher SES and younger adults reporting greater discrimination may be at particular risk for accelerated aging. Telomere attrition promotes and accelerates chronic health conditions for which there are health disparities. Future research explicating intersections among specific discrimination indices and social categories is warranted.

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Section: Discussionsupporting

confidence: 81%

Interpersonal-level discrimination indices, sociodemographic factors, and telomere length in African-Americans and Whites

Moody

Leibel

Darden

et al. 2019

Biological Psychology

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“…We did not find any comparable studies in the literature to interpret this unexpected finding, however, other studies do show paradoxical relationships for BMI among African American populations, particularly women, compared to other populations [42,43]. For example, significant interactions by race and poverty have been shown where African Americans who were living in poverty had lower BMI, waist circumference, and higher HDL cholesterol compared to those not living in poverty, whereas the opposite associations were shown for Whites [42]. In older adults, particularly those over age 65, moderate obesity later in life might improve survival and alleviate frailty [44].…”

Section: Discussioncontrasting

confidence: 82%

Changes in perceptions of neighborhood environment and Cardiometabolic outcomes in two predominantly African American neighborhoods

et al. 2020

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Background: Perceived neighborhood characteristics, including satisfaction with one's neighborhood as a place to live, are associated with lower obesity rates and more favorable cardiovascular risk factor profiles. Yet, few studies have evaluated whether changes in perceived neighborhood characteristics over time may be associated with cardiometabolic health indicators. Methods: Changes in perception of one's neighborhood (2013)(2014)(2015)(2016) were determined from a cohort of residents who lived in one of two low-income urban neighborhoods. Changes were categorized into the following: improvement vs. no change or worsening over the three-year time-period. Multivariable linear regression was used to measure the association between perceived improvement in each of the neighborhood characteristics with cardiometabolic outcomes (BMI, SBP, DBP, HbA1c, HDL-c) that were assessed in 2016, and compared with those who perceived no change or worsening of neighborhood characteristics. Models were adjusted for age, sex, income, education, marital status, physical function, neighborhood, and years spent in neighborhood. To examine potential sex differences, follow-up models were conducted and stratified by sex. Results: Among the 622 individuals who remained in the same neighborhood during the time period, 93% were African American, 80% were female, and the mean age was 58 years. In covariate-adjusted models, those who perceived improvement in their neighborhood safety over the time period had a significantly higher BMI (kg/m 2 ) than those who perceived no improvement or worsening (β = 1.5, p = 0.0162); however, perceived improvement in safety was also significantly associated with lower SBP (mmHg) (β = − 3.8, p = 0.0361). When results were stratified by sex, the relationship between improved perceived neighborhood safety and BMI was only evident in females. Conclusions: These findings suggest that perceived neighborhood characteristics may impact cardiometabolic outcomes (BMI, SBP), but through differing pathways. This highlights the complexity of the associations between neighborhood characteristics and underscores the need for more longitudinal studies to confirm the associations with cardiometabolic health in African American populations.

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“…Please see online supplement for further descriptive stratification, and the findings of Waldstein and colleagues 21 for information regarding variability of cardiovascular risk factors across groups. Overall, participants were approximately 44% men, 57% African-American, and ranged in age from 30 to 64 years (mean=48 years).…”

Section: Resultsmentioning

confidence: 99%

Distributions of Subclinical Cardiovascular Disease in a Socioeconomically and Racially Diverse Sample

Wendell

Waldstein

Evans

et al. 2017

Stroke

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Background and Purpose Differential subgroup vulnerability to subclinical cardiovascular disease (CVD) is likely, and yet few, if any, studies have addressed interactive relations of age, sex, race, and socioeconomic status (SES) to these conditions to examine nuances of known health disparities. We examined distributions of carotid atherosclerosis and arterial stiffness in a socioeconomically diverse, biracial, urban sample. Methods Participants (n=2,270) in the population-based Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study (30–64 years old, 44% men, 57% African-American, 39% with household income below 125% federal poverty threshold) underwent carotid intimal medial thickness (IMT) and pulse wave velocity (PWV) assessment. Results In cross-sectional hierarchical regression analyses, interactive race×SES effects were identified for IMT and PWV, such that high SES African-Americans had significantly thicker IMTs and faster PWVs than all other subgroups (i.e., low SES African-Americans, low SES whites, and high SES whites). A race×sex effect was also identified for IMT, such that the IMT discrepancy between white men and women was more pronounced than the discrepancy between African-American men and women. Lastly, an SES×sex effect indicated that while IMTs of high SES and low SES men did not significantly differ, high SES women had marginally thicker IMTs than low SES women. Conclusions High SES African-Americans may be particularly vulnerable to subclinical CVDs, placing them at enhanced risk for clinical CVDs including stroke. These findings suggest that male sex, low socioeconomic status, and African-American ancestry may represent imprecise generalizations as risk factors for subclinical CVD.

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Cross-sectional relations of race and poverty status to cardiovascular risk factors in the Healthy Aging in Neighborhoods of Diversity across the Lifespan (HANDLS) study

Cited by 16 publications

References 31 publications

Interpersonal-level discrimination indices, sociodemographic factors, and telomere length in African-Americans and Whites

Interpersonal-level discrimination indices, sociodemographic factors, and telomere length in African-Americans and Whites

Changes in perceptions of neighborhood environment and Cardiometabolic outcomes in two predominantly African American neighborhoods

Distributions of Subclinical Cardiovascular Disease in a Socioeconomically and Racially Diverse Sample

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