Neighbourhood socioeconomic status and biological 'wear and tear' in a nationally representative sample of US adults

Abstract

Objective To assess whether neighbourhood socioeconomic status (NSES) is independently associated with disparities in biological “wear and tear”—measured by allostatic load (AL)—in a nationally representative sample of U.S. adults. Design Cross-sectional study. Setting Population-based U.S. survey, the Third National Health and Nutrition Examination Survey (NHANES III), merged with U.S. Census data describing respondents’ neighbourhoods. Participants 13,184 adults from 83 counties and 1,805 census tracts who completed NHANES III interviews and medical examinations and whose residential addresses could be reliably geocoded to census tracts. Main Outcome Measures A summary measure of biological risk, incorporating nine biomarkers that together represent AL across metabolic, cardiovascular, and inflammatory subindices. Results Being male, older, having lower income, less education, being Mexican-American, and being both Black and female were all independently associated with worse AL. After adjusting for these characteristics, living in a lower SES neighbourhood was associated with worse AL (coeff. = −0.46; CI −0.079, −0.012). The relationship between NSES and AL did not vary significantly by gender or race/ethnicity. Conclusions Living in a lower SES neighbourhood in the United States is associated with significantly greater biological wear and tear as measured by AL, and this relationship is independent of individual SES characteristics. Our findings demonstrate that where one lives is independently associated with AL, thereby suggesting that policies that improve NSES may also yield health returns.

Allostatic load and biological anthropology

“…Cut-points defined by quartiles Seeman et al (1997Seeman et al ( , 2001Seeman et al ( , 2002, Seeman, Crimmins, et al (2004), Seeman, Glei, et al (2004), Kubzansky et al (1999), Karlamangla et al (2002Karlamangla et al ( , 2014, Schnorpfeil et al (2003), Weinstein et al (2003), Hampson et al (2009), Lipowicz et al (2014, Riva et al (2014), Barboza Solís et al (2015), Gale et al (2015), Horan and Widom (2015), McClure et al (2015), Zilioli et al (2015), Hansen et al (2016), Kusano et al (2016), and Robertson and Watts (2016) Cut-points defined by deciles Goldman et al (2005), Glei et al (2007), and Hwang et al (2014) Cut-points defined using clinical criteria Seeman et al (2008), Hampson et al (2009), Bird et al (2010 and Rosenberg et al (2014) Cut-points defined using a combination of clinical criteria and either deciles or quartiles (2015), Gale et al (2015), and Robertson and Watts (2016) Use of two-tailed cut-points Hampson et al (2009) and Hwang et al (2014) Use of recursive partitioning to calculate allostatic load Gruenewald et al (2006) Allostatic load scored by system rather than by biomarkers Karlamangla et al (2014), Seeman et al (2014), Gay et al (2015), and Zilioli et al (2015) Calculated allostatic...…”

Neighborhood Socioeconomic Status in Relation to Serum Biomarkers in the Black Women’s Health Study

“…8,11 Inflammation plays a critical role in all stages of the CVD disease process. 12,13 Studies examining the association between neighborhood SES and physiologic indicators of inflammation, including C-reactive protein, interleukin-6 (IL-6), 14 and serum albumin, 15 have found higher levels of 14,15 proinflammatory markers in residents of disadvantaged communities than in wealthier communities. 14,15 Black women at all levels of education are more likely to live in poor neighborhoods than are white women [16][17][18][19] ; thus, it is important to determine whether low neighborhood SES is associated with cardiovascular risk factors independent of individual-level SES.…”

“…12,13 Studies examining the association between neighborhood SES and physiologic indicators of inflammation, including C-reactive protein, interleukin-6 (IL-6), 14 and serum albumin, 15 have found higher levels of 14,15 proinflammatory markers in residents of disadvantaged communities than in wealthier communities. 14,15 Black women at all levels of education are more likely to live in poor neighborhoods than are white women [16][17][18][19] ; thus, it is important to determine whether low neighborhood SES is associated with cardiovascular risk factors independent of individual-level SES. Previous studies of neighborhood SES and biomarkers that included black women were limited to low SES communities 5,20 and the elderly 21 or had too few subjects to allow for specific analyses of black women across SES.…”

Social Determinants of Risk and Outcomes for Cardiovascular Disease

“…34,[268][269][270][271][272][273][274] This is an important consideration because it may be possible to use clinical 109 and public health interventions 92 to reduce this burden, thereby narrowing health disparities. Second, social and economic stresses lead to a biological wear and tear, or allostatic stress response, [275][276][277][278][279][280] involving a number of pathways, including stimulation of stress hormones, [280][281][282] inflammation, 283 endothelial dysfunction, thrombosis, vascular hyperreactivity, 270,274,[284][285][286][287] and metabolic disturbances. 270,285,288,289 Third, the effects of socioeconomic disadvantage in utero and in early childhood have long-term anatomical and physiological effects that lead to CVD in adulthood.…”