We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Neighborhood Characteristics and Elevated Blood Pressure in Older Adults.
- Authors
Sims, Kendra D.; Willis, Mary D.; Hystad, Perry W.; Batty, G. David; Bibbins-Domingo, Kirsten; Smit, Ellen; Odden, Michelle C.
- Abstract
This cohort study examines data from Health and Retirement Study participants to determine associations between blood pressure control and sociodemographic, economic, and housing factors at the census tract level. Key Points: Question: Which sociodemographic, economic, and housing neighborhood factors are associated with elevated blood pressure among older adults? Findings: In this cohort study of a nationwide sample of 12 946 adults older than 50 years, 1 of 51 evaluated census tract factors had statistically significant associations with blood pressure control after adjustment for multiple comparisons and individual-level confounders. Residing in a census tract experiencing the highest vs lowest tertile of post-1999 in-migration of homeowners was associated with reduced relative risk of elevated blood pressure from 2006 to 2016; this association was only present among non-Hispanic White participants. Meaning: Gentrification via in-migration of homeowners may influence later-life blood pressure control. Importance: The 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. Objective: To evaluate independent associations of sociodemographic, economic, and housing neighborhood factors with elevated blood pressure. Design, Setting, and Participants: In 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. Exposures: Fifty-one standardized American Community Survey census tract variables (2005-2009). Main Outcomes and Measures: Elevated 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. Results: Of 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 Relevance: In 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.
- Subjects
HYPERTENSION risk factors; RACISM; CONFIDENCE intervals; MULTIVARIATE analysis; HOUSING stability; RESIDENTIAL segregation; SPHYGMOMANOMETERS; DESCRIPTIVE statistics; SOCIAL classes; HEALTH equity; NEIGHBORHOOD characteristics; LONGITUDINAL method; OLD age
- Publication
JAMA Network Open, 2023, Vol 6, Issue 9, pe2335534
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.35534