267095 Residential Segregation and Racial Disparities in Hypertension Awareness and Control

Tuesday, October 30, 2012

Roland J. Thorpe Jr., PhD , Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Emma McGinty, MS , Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Rachel McCleary, BA , Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Kelly Bower, MSN/MPH, RN , School of Nursing, Johns Hopkins University, Baltimore, MD
Charles Rohde, PhD , Department of Biostatistics, 615 N. Wolfe St, Baltimore, MD
Darrell Gaskin, PhD , Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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.

Learning Areas:
Chronic disease management and prevention
Diversity and culture

Learning Objectives:
Describe how segregation affects disparites in hypertension awareness and management

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Myresearch interest focuses on understanding the etiology of race- and SES-related disparities in functional and health status of community-dwelling adults across the life course encompasses three areas: 1) social factors (mainly race and SES) that influence functional and health outcomes in middle to late life; 2) race, segregation and health outcomes; and 3) menís health.
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.