Residential Segregation and Racial Disparities in Hypertension Awareness and Control

Previous research has examined several factors that may explain race disparities in hypertension awareness and management; however, these studies have not accounted for the role of segregation in explaining these disparities. African Americans and whites tend to live in very different social environments; therefore, it is likely that race differences in hypertension awareness and management result from race differences in health risk exposures and/or healthcare resources related to residential segregation. We examined the relationship between race, residential segregation, and hypertension awareness and control in 1833 hypertensive African Americans (31.1%) and whites (68.9%) aged 25 years and older in the National Health and Nutrition Examination Study (NHANES) 1999-2004. Hypertension was defined as systolic blood pressure (BP) ≥ 140 mm Hg, or diastolic BP ≥ 90 mm Hg, or if the participant reported taking antihypertensive medications. Hypertensive participants who self-report having been diagnosed by a doctor were considered to be aware of their hypertension (n=1360 (32.1% African American)). Among the treated hypertensive participants, those with systolic BP<140 mmHg and diastolic BP<90 mmHg were considered to be controlled (n=665 (27.1% African American)). Our measure of segregation was based on the combination of an individual's race and their neighborhood racial composition. We created the following race/place categories: white in white neighborhood, white in black neighborhood, white in other race neighborhood, white in integrated neighborhood, black in black neighborhood, black in white neighborhood, black in other race neighborhood, and black in integrated neighborhood. Adjusting for demographic and health related factors, African Americans living in white neighborhoods (odds ratio [OR] =1.47, 95% confidence interval [CI] 1.08, 1.98) and African Americans living in integrated neighborhoods (OR =1.62, 95% CI 1.12, 2.36) had greater odds of being aware of their hypertension compared to whites living in white neighborhoods. With regard to hypertension control, African Americans living in a black neighborhood had a lower odds of having controlled hypertension (OR =0.64, 95% CI 0.49, 0.84) than whites living in white neighborhoods. In this nationally representative sample, racial composition of where African Americans lived had an impact on their hypertension awareness and control. Public health campaigns targeting hypertension awareness and management should account for aspects of an individual's social and environmental conditions which have implications for access to and quality of care.