Trajectories of neighborhood poverty and associations with subclinical atherosclerosis and associated risk factors: the multi-ethnic study of atherosclerosis

Abstract

The authors used data from the Multi-Ethnic Study of Atherosclerosis and latent trajectory class modeling to determine patterns of neighborhood poverty over 20 years (1980-2000 residential history questionnaires were geocoded and linked to US Census data). Using these patterns, the authors examined 1) whether trajectories of neighborhood poverty were associated with differences in the amount of subclinical atherosclerosis (common carotid intimal-media thickness) and 2) associated risk factors (body mass index, hypertension, diabetes, current smoking) at baseline (January 2000-August 2002). The authors found evidence of 5 stable trajectory groups with differing levels of neighborhood poverty ( approximately 6%, 12%, 20%, 30%, and 45%) and 1 group with 29% poverty in 1980 and approximately 11% in 2000. Mostly for women, higher cumulative neighborhood poverty was generally significantly associated with worse cardiovascular outcomes. Trends generally persisted after adjustment for adulthood socioeconomic position and race/ethnicity, although they were no longer statistically significant. Among women who had moved during the 20 years, the long-term measure had stronger associations with outcomes (except smoking) than a single, contemporaneous measure. Results indicate that cumulative 20-year exposure to neighborhood poverty is associated with greater cardiovascular risk for women. In residentially mobile populations, single-point-in-time measures underestimate long-term effects.

Figure 1.

Adjusted mean differences in common carotid intimal-media thickness (CIMT) (μm), and 95% confidence intervals, for neighborhood trajectory classes compared with the low stable group for A) males and B) females. Solid vertical line: age adjusted; dotted vertical line: age–adult socioeconomic position and race adjusted. P for trend (stable groups only)—age adjusted: A) 0.2362, B) 0.0002; age–adult socioeconomic position and race adjusted: A) 0.3451, B) 0.2568.

Figure 2.

Adjusted mean differences in body mass index (BMI), and 95% confidence intervals, for neighborhood trajectory classes compared with the low stable group for A) males and B) females. Solid vertical line: age adjusted; dotted vertical line: age–adult socioeconomic position and race adjusted. P for trend (stable groups only)—age adjusted: A) 0.6932, B) <0.001; age–adult socioeconomic position and race adjusted: A) 0.0022, B) 0.1043.

Figure 3.

Adjusted relative prevalences of hypertension, and 95% confidence intervals, for neighborhood trajectory classes compared with the low stable group for A) males and B) females. Solid vertical line: age adjusted; dotted vertical line: age–adult socioeconomic position and race adjusted. P for trend (stable groups only)—age adjusted: A) 0.0962, B) <0.001; age–adult socioeconomic position and race adjusted: A) 0.1925, B) 0.5045.

Figure 4.

Adjusted relative prevalences, and 95% confidence intervals, of diabetes for neighborhood trajectory classes compared with the low stable group for A) males and B) females. Solid vertical line: age adjusted; dotted vertical line: age–adult socioeconomic position and race adjusted. P for trend (stable groups only)—age adjusted: A) 0.0055, B) <0.0001; age–adult socioeconomic position and race adjusted: A) 0.4063, B) 0.0012.

Figure 5.

Adjusted relative prevalences, and 95% confidence intervals, of current smoking for neighborhood trajectory classes compared with the low stable group for A) males and B) females. Solid vertical line: age adjusted; dotted vertical line: age–adult socioeconomic position and race adjusted. P for trend (stable groups only)—age adjusted: A) <0.0001, B) 0.0008; age–adult socioeconomic position and race adjusted: A) 0.1904, B) 0.2246.