Association between neighborhood-level socioeconomic deprivation and incident hypertension: A longitudinal analysis of data from the Dallas heart study

• Published in: The American heart journal Vol. 204; pp. 109 - 118
• Main Authors: Claudel, Sophie E., Adu-Brimpong, Joel, Banks, Alnesha, Ayers, Colby, Albert, Michelle A., Das, Sandeep R., de Lemos, James A., Leonard, Tammy, Neeland, Ian J., Rivers, Joshua P., Powell-Wiley, Tiffany M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2018; Elsevier Limited
• Subjects: Adult; African Americans; Blood pressure; Cardiovascular disease; Cardiovascular diseases; Charitable foundations; Coronary artery disease; Critical point; Data collection; Data processing; Deprivation; Economic Status; Ethnicity; Factor analysis; Family medical history; Female; Guidelines; Health disparities; Health risks; Heart; Heart diseases; Hispanic Americans; Humans; Hypertension; Hypertension - epidemiology; Incidence; Longitudinal Studies; Male; Middle Aged; Minority & ethnic groups; Mortality; Neighborhoods; Perceptions; Population; Poverty Areas; Regression analysis; Residence Characteristics - statistics & numerical data; Risk analysis; Risk Factors; Socioeconomic factors; Texas - epidemiology; Texas; United States > US
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2018.07.005

Cardiovascular disease is a leading economic and medical burden in the United States (US). As an important risk factor for cardiovascular disease, hypertension represents a critical point of intervention. Less is known about longitudinal effects of neighborhood deprivation on blood pressure outcomes, especially in light of new hypertension guidelines.
Longitudinal data from the Dallas Heart Study facilitated multilevel regression analysis of the relationship between neighborhood deprivation, blood pressure change, and incident hypertension over a 9-year period. Factor analysis explored neighborhood perception, which was controlled for in all analyses. Neighborhood deprivation was derived from US Census data and divided into tertiles for analysis. Hypertension status was compared using pre-2017 and 2017 hypertension guidelines.
After adjusting for covariates, including moving status and residential self-selection, we observed significant associations between residing in the more deprived neighborhoods and 1) increasing blood pressure over time and 2) incident hypertension. In the fully adjusted model of continuous blood pressure change, significant relationships were seen for both medium (SBP: β = 4.81, SE = 1.39, P = .0005; DBP: β = 2.61, SE = 0.71, P = .0003) and high deprivation (SBP: β = 7.64, SE = 1.55, P < .0001; DBP: β = 4.64, SE = 0.78, P < .0001). In the fully adjusted model of incident hypertension, participants in areas of high deprivation had 1.69 higher odds of developing HTN (OR 1.69; 95% CI 1.02, 2.82), as defined by 2017 hypertension guidelines. Results varied based on definition of hypertension used (pre-2017 vs. 2017 guidelines).
These findings highlight the potential impact of adverse neighborhood conditions on cardiometabolic outcomes, such as hypertension.