Neighborhood disadvantage, neighborhood safety and cardiometabolic risk factors in African Americans: biosocial associations in the Jackson Heart study

Abstract

Objective: We examined associations between neighborhood socioeconomic disadvantage, perceived neighborhood safety and cardiometabolic risk factors, adjusting for health behaviors and socioeconomic status (SES) among African Americans.

Methods: Study participants were non-diabetic African Americans (n = 3,909) in the baseline examination (2000-2004) of the Jackson Heart Study. We measured eight risk factors: the metabolic syndrome, its five components, insulin resistance and cardiovascular inflammation. We assessed neighborhood socioeconomic disadvantage with US Census 2000 data. We assessed perceived neighborhood safety, health behaviors and SES via survey. We used generalized estimating equations to estimate associations with a random intercept model for neighborhood effects.

Results: After adjustment for health behaviors and SES, neighborhood socioeconomic disadvantage was associated with the metabolic syndrome in women (PR 1.13, 95% CI 1.01, 1.27). Lack of perceived safety was associated with elevated glucose (OR 1.36, 95% CI 1.03, 1.80) and waist circumference (PR 1.06, 95% CI 1.02, 1.11) among women, and with elevated glucose (PR 1.30, 95% CI 1.02, 1.66) and insulin resistance (PR 1.25, 95% CI 1.08, 1.46) among men.

Conclusions: Neighborhood socioeconomic disadvantage and perceived safety should be considered as targets for intervention to reduce cardiometabolic risks among African Americans.

Figure 1. Unadjusted Percentage of Cardiometabolic Risk Factors between Neighborhood Socioeconomic Disadvantage among Women and Men in the Jackson Heart Study, 2000–2004.

Excludes diabetics consistent with ATP III consensus guidelines and individuals with ≤400 kcal daily energy intake. Diabetes is defined as self-reported type I or II diabetes; taking diabetes medications; having a measured fasting plasma glucose equal to or greater than 126 mg/dL; measured hemoglobin A1C of 6.5% or greater. Elevated glucose (“pre-diabetes”) is defined as a measured fasting plasma glucose between 100–125 mg/dL, consistent with American Diabetes Association recommendations. Sex specific norms are used to define elevated waist circumference and low HDL measurement. Elevated blood pressure is defined as systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥85 mmHg. Elevated triglycerides are defined as ≥150 mg/dL. Elevated hsCRP is defined as hsCRP≥3.0 (mg/L), elevated insulin resistance is defined as HOMA-IR greater than or equal to 3.31. *p≤0.05 **p≤0.01.

Figure 2. Unadjusted Percentage of Cardiometabolic Risk Factors between Neighborhood Safety among Women and Men in the Jackson Heart Study, 2000–2004.

Excludes diabetics consistent with ATP III consensus guidelines and individuals with ≤400 kcal daily energy intake. Diabetes is defined as self-reported type I or II diabetes; taking diabetes medications; having a measured fasting plasma glucose equal to or greater than 126 mg/dL; measured hemoglobin A1C of 6.5% or greater. Elevated glucose (“pre-diabetes”) is defined as a measured fasting plasma glucose between 100–125 mg/dL, consistent with American Diabetes Association recommendations. Sex specific norms are used to define elevated waist circumference and low HDL measurement. Elevated blood pressure is defined as systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥85 mmHg. Elevated triglycerides are defined as ≥150 mg/dL. Elevated hsCRP is defined as hsCRP ≥3.0 (mg/L), elevated insulin resistance is defined as HOMA-IR greater than or equal to 3.31. **p≤0.01.