Neighborhood SES is particularly important to the cardiovascular health of low SES individuals

Abstract

Rationale: Health disparities defined by neighborhood socioeconomic status (SES) are well established; it is less well understood whether neighborhood SES is differentially associated with health depending on one's own SES.

Objective: The double jeopardy hypothesis, collective resources model, fundamental cause theory, and relative deprivation hypothesis support differential patterns of association between neighborhood and individual SES with health. The first three models suggest that higher neighborhood SES predicts health more strongly among lower, as compared to higher, SES individuals. The relative deprivation hypothesis suggests that higher SES neighborhoods bring no extra health benefit to low SES individuals and could even bring a health deficit. This study examined competing hypotheses with prospective associations between cardiovascular (CV) health and individual SES, neighborhood SES, and their interaction.

Method: Data were from two waves of the Midlife in the United States (MIDUS) Study (N = 1012), a national survey of adults ages 25 and older at baseline. Neighborhood SES was a composite of five census tract-level SES indicators from the 1990 census. Individual SES was a composite of educational attainment and household income at wave one (1995-1996). CV health at wave two (2004-2008), was computed as a composite based on smoking status, body mass index, physical activity, diet, total cholesterol, blood pressure, and glucose.

Results: Individual and neighborhood SES were each associated with CV health net of baseline health status and other covariates. Interactions between individual and neighborhood SES showed that higher neighborhood SES was associated with better CV health for those of lower, not higher, individual SES.

Conclusion: Results are consistent with the double jeopardy hypothesis, the collective resources model, and the fundamental cause theory, but not with a relative deprivation hypothesis. Results suggest that additional attention to the neighborhood socioeconomic context of lower SES individuals may reduce SES disparities in cardiovascular health.

Keywords: Cardiovascular health; Double jeopardy hypothesis; Neighborhood socioeconomic status; Socioeconomic status.

Figure 1

Histogram of cardiovascular health scores from wave two of the MIDUS biomarker sample.

Figure 2

Interaction between neighborhood and individual SES in the prospective prediction of cardiovascular health. Lines represent the association between neighborhood SES and cardiovascular health at the mean and plus and minus one standard deviation of individual SES. Simple slopes are significantly different from zero at low and mean levels of individual SES. Estimated values reflect statistical adjustment for age, gender, race, physical activity, smoking, chronic conditions, and hypertension, cholesterol, and diabetes medication at baseline.