Neighborhood Characteristics and Elevated Blood Pressure in Older Adults

Abstract

ImportanceThe local environment remains an understudied contributor to elevated blood pressure among older adults. Untargeted approaches can identify neighborhood conditions interrelated with racial segregation that drive hypertension disparities.ObjectiveTo evaluate independent associations of sociodemographic, economic, and housing neighborhood factors with elevated blood pressure.Design, Setting, and ParticipantsIn this cohort study, the sample included Health and Retirement Study participants who had between 1 and 3 sets of biennial sphygmomanometer readings from 2006 to 2014 or 2008 to 2016. Statistical analyses were conducted from February 5 to November 30, 2021.ExposuresFifty-one standardized American Community Survey census tract variables (2005-2009).Main Outcomes and MeasuresElevated sphygmomanometer readings over the study period (6-year period prevalence): a value of at least 140 mm Hg for systolic blood pressure and/or at least 90 mm Hg for diastolic blood pressure. Participants were divided 50:50 into training and test data sets. Generalized estimating equations were used to summarize multivariable associations between each neighborhood variable and the period prevalence of elevated blood pressure, adjusting for individual-level covariates. Any neighborhood factor associated (Simes-adjusted for multiple comparisons P ≤ .05) with elevated blood pressure in the training data set was rerun in the test data set to gauge model performance. Lastly, in the full cohort, race- and ethnicity-stratified associations were evaluated for each identified neighborhood factor on the likelihood of elevated blood pressure.ResultsOf 12 946 participants, 4565 (35%) had elevated sphygmomanometer readings (median [IQR] age, 68 [63-73] years; 2283 [50%] male; 228 [5%] Hispanic or Latino, 502 [11%] non-Hispanic Black, and 3761 [82%] non-Hispanic White). Between 2006 and 2016, a lower likelihood of elevated blood pressure was observed (relative risk for highest vs lowest tertile, 0.91; 95% CI, 0.86-0.96) among participants residing in a neighborhood with recent (post-1999) in-migration of homeowners. This association was precise among participants with non-Hispanic White and other race and ethnicity (relative risk, 0.91; 95% CI, 0.85-0.97) but not non-Hispanic Black participants (relative risk, 0.97; 95% CI, 0.85-1.11; P = .48 for interaction) or Hispanic or Latino participants (relative risk, 0.84; 95% CI, 0.65-1.09; P = .78 for interaction).Conclusions and RelevanceIn this cohort study of older adults, recent relocation of homeowners to a neighborhood was robustly associated with reduced likelihood of elevated blood pressure among White participants but not their racially and ethnically marginalized counterparts. Our findings indicate that gentrification may influence later-life blood pressure control.

Impact of Social Determinants of Health on Hypertension Outcomes: A Systematic Review

“…68 Neighborhood environment was examined in 58% (n=33) of the studies 14,22,26,27,30,32,35,38,[41][42][43][44]46,[49][50][51][52][53][55][56][57][59][60][61][62][63][64]66,[70][71][72][73][74] as a primary contributor using several variables including neighborhood problems, 14 safety, 14 crime, 50,52 walkability 22,43,51,52,55,62,70,73 and SES, 22,43,51,52,55,62,…”

“…In this systematic review of 57 articles, the outcomes of interest focused on various hypertension metrics. Hypertension prevalence 14,22,23,26,28,29,36,40,41,45,46,48,49,52,55,56,59,60,63,66,67,69,70,[73][74][75][76] was the most frequently examined outcome, featured in 47% of the studies. Hypertension incidence 27,32,35,36,39,42,44,47,51,61 was reported in 18% of the studies, while hypertension control 28,31,33,34,38,65 and hypertension diagnosis 24,30,37,53,57,58,64,…”

“…Overall, as neighborhood characteristics declined, BP worsened in most of the studies. 26,27,35,44,49,50,57,61,62,64,66 For example, Chambers et al 26 found a 25% higher prevalence of hypertension among renters residing in high foreclosure risk areas (compared with low foreclosure risk areas). Similarly, 2 studies 27,74 found higher BP among adults residing in more deprived neighborhoods (compared with the least deprived).…”