218977 Racial residential segregation and Black-White hypertension disparities

Tuesday, November 9, 2010 : 2:50 PM - 3:05 PM

Kiarri N. Kershaw, MPH , Department of Epidemiology, University of Michigan, Ann Arbor, MI
Ana V. Diez Roux, MD, PhD , Department of Epidemiology, Center for Integrative Approaches to Health Disparities, University of Michigan, Ann Arbor, MI
Sarah A. Burgard, PhD , Department of Sociology & Population Studies Center, University of Michigan, Ann Arbor, MI
Lynda Lisabeth, PhD , Department of Epidemiology, University of Michigan, Ann Arbor, MI
Mahasin S. Mujahid, MS, PhD , Division of Epidemiology, University of California, Berkeley, Berkeley, CA
Amy J. Schulz, PhD MPH , Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI
Background: Recent evidence suggests environmental factors may contribute to the large US Black-White disparities in hypertension, but the mechanisms remain unclear. Few studies have examined geographic variation in hypertension disparities, but studies of other health outcomes indicate that racial residential segregation may help explain these inequalities. Objective: To determine whether Black-White hypertension disparities vary by level of residential segregation. Sample: 8,541 participants of the 1999-2006 National Health and Nutrition Examination Surveys aged 25+ living in metropolitan areas. Methods: Metropolitan-level racial segregation was measured using the black isolation index (extent to which Blacks are spatially isolated from other groups). Hypertension was defined as systolic blood pressure ≥ 140 mm Hg, diastolic pressure ≥ 90 mm Hg, or use of anti-hypertensive medication. Using restricted-use area-level identifiers, accessed through the National Center for Health Statistics Research Data Center, multilevel logistic models were used to assess Black-White differences in the odds of hypertension. Results: After adjusting for age, sex, education, and income, Blacks had 2.71 times higher odds of hypertension than Whites (95% Confidence Interval (CI): 2.28, 3.22). However, this relationship varied significantly by level of segregation (p for interaction=0.001). In areas with an isolation index score in the 10th percentile (low segregation), Blacks had 1.57 times higher odds of hypertension (95% CI: 1.02, 2.41) compared with 3.61 (95% CI: 2.90, 4.49) in areas scoring in the 90th percentile (high segregation). Conclusion: These findings suggest that racial segregation may contribute to Black-White hypertension disparities. Future research will explore potential neighborhood-level pathways underlying this relationship.

Learning Areas:
Chronic disease management and prevention
Epidemiology

Learning Objectives:
1. Explain the rationale for examining factors underlying geographic variation in Black-White hypertension disparities. 2. Describe the potential pathways through which residential segregation can lead to health disparities.

Keywords: Health Disparities, Hypertension

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I conceptualized the research project under the guidance of my dissertation advisor and I conducted all the analyses.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4268.0: Epidemiology of social justice and health disparities