Online Program

An examination of the associations among neighborhood racial composition, neighborhood poverty, access to care, perceived discrimination and hypertension treatment: Does your zip code determine your health outcomes?

Tuesday, November 5, 2013 : 8:50 a.m. - 9:10 a.m.

Jennifer A. Hartfield, PhD(c), MPH, MCHES, Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI
Amy J. Schulz, PhD, Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI
Vicki Johnson-Lawrence, MS, PhD, Public Health & Health Sciences, University of Michigan-Flint, Flint, MI
Denise White-Perkins, MD, PhD, Henry Ford Health System, Detroit, MI
Background. Untreated hypertension is a fatal risk factor for coronary heart disease and is a strong predictor of uncontrolled hypertension. Untreated hypertension is more prevalent among men, racial/ethnic minorities, and impoverished populations. Residents of predominantly non-Hispanic Black and high-poverty neighborhoods maybe less likely to achieve hypertension control partly due to perceived discrimination and difficulty accessing healthcare, but the mechanisms through which these associations unfold have not been fully elucidated. In previous research, we found hypertensive non-Hispanic Blacks were more likely to be aware of their hypertension, but paradoxically, had lower treatment rates than non-Hispanic White and Hispanic Detroit residents. Data and Methods. We used two level hierarchical linear models to assess whether neighborhood racial composition and neighborhood poverty are correlates of hypertension treatment, and whether these associations are mediated by access to healthcare. Our data are from a multiethnic sample of Detroit residents (aged25+), conducted by the Healthy Environments Partnership, a CBPR partnership in Detroit. Results & Implications. Neighborhoods with higher concentrations of Blacks OR = 1.02, CI (95%, 1.00, 1.03), older adults OR = 1.06 CI (95%, 1.01, 1.10), and females OR = 5.37 CI (95%, 1.86, 15.46) were associated with higher odds of treatment. Surprisingly, individuals who reported occasions of perceived discrimination were more likely to receive treatment OR=3.36 CI (95%, CI 1.08, 10.49). Delays in seeking healthcare were negatively associated with receiving treatment OR= 0.17 (CI 95%, 0.03, 0.92). Results from these analyses inform priorities for intervention by identifying characteristics of neighborhoods associated with hypertension treatment efforts.

Learning Areas:

Chronic disease management and prevention
Diversity and culture
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Provision of health care to the public
Public health or related research

Learning Objectives:
Identify potential neighborhood characteristics and conditions that may influence hypertension treatment. Identify public health strategies for intervening to improve the effectiveness of hypertension treatment.

Keyword(s): Hypertension, Access to Health Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been a graduate research assistance for the past four years. My research interests focus on hypertension awareness, treatment, and control. Specifically, I examine the impact of neighborhood racial composition, neighborhood poverty, perceived discrimination, and access to care on hypertension awareness, treatment and control.
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.