Neighborhood Disadvantage and Variations in Blood Pressure

Purpose: To examine the extent to which the distribution of neighborhood disadvantage accounts for the variation in blood pressure after justifying its individual-level risk factors.

Methods: Data from community screenings conducted as part of the Community Initiatives to Eliminate Stroke Project in NC (2004-2008) were used. A total of 19,261 adults participated in the screenings. 14,510 participant addresses were successfully geocoded. Both individual and neighborhood risks of hypertension were defined. Mixed model analysis was applied to formulate three hierarchical linear models.

Results: 24% of the 14,510 participants had a systolic blood pressure (SBP) of ≥140 mmHg, and 15% had a diastolic blood pressure (DBP) of ≥90 mmHg. At the neighborhood level, model 1 found the significant variation in both average SBP and DBP across the neighborhood census block groups (p<0.001). Model 2 suggested that on average, individual risks (e.g. age, gender, body mass index, high density lipoprotein, triglyceride, self-reported stress and smoking) were significantly associated with an individual's SBP and DBP within each block group (p<0.05). In model 3, neighborhood composite deprivation index had a significant impact on an average SBP (p=0.009) while neighborhood car ownership and home ownership had a significant impact on an average DBP (p<0.05). Both model 2 and model 3 found the significant random effects among the block groups for the average DBP.

Discussion: The findings highlight the combined role of individual and neighborhood characteristics on SBP and DBP. Changing or modifying neighborhood contexts will help to reduce the environmental risks of hypertension.