Neighbourhood characteristics and cumulative biological risk: evidence from the Jamaica Health and Lifestyle Survey 2008: a cross-sectional study

Abstract

Objective: To examine whether neighbourhood characteristics are associated with cumulative biological risk (CBR) and sex differences in CBR in a nationally representative sample in Jamaica, a small island developing country with increasing prevalence of non-communicable diseases (NCDs).

Design: Cross-sectional study SETTING: A population-based cross-sectional survey, the Jamaica Health and Lifestyle Survey 2008 (JHLS II) recruited persons at their homes over a 4 month period from all 14 parishes and 113 neighbourhoods defined as enumeration districts (EDs).

Participants: 2544 persons aged 15-74 years old from the 2008 Jamaica Health and Lifestyle Survey (JHLS II), who completed interviewer-administered questionnaires and had biomarkers assessed, and whose home addresses could be reliably geocoded.

Primary outcome: A summary measure CBR was created using seven markers-systolic and diastolic blood pressure readings, waist circumference, body mass index, total cholesterol, fasting blood glucose levels and self-reported asthma. Weighted multilevel models examined clustering, using the intraclass correlation coefficient (ICC), of CBR across neighbourhoods and the impact of neighbourhood characteristics (recreational space availability and neighbourhood disorder) on CBR.

Results: Women had significantly higher mean CBR scores than men across all age groups. There was significant clustering of CBR by ED, and among women versus men (ICC: F=6.9%, M=0.7%). Women living in more disordered neighbourhoods were 26% more likely to have high CBR as those in less disordered ones (aOR=1.26, 95% CI=1.08 to 1.47; p<0.05). Individuals living in EDs with greater recreational space availability were 25% less likely to have a high CBR (aOR=0.75, 95% CI=0.64 to 0.90; p<0.05).

Conclusions: Policy-makers in Jamaica should pay greater attention to neighbourhood factors such as recreational space availability and neighbourhood disorder that may contribute to CBR in any effort to curtail the epidemic of NCDs.

Keywords: cumulative biological risk; developing country; neighbourhoods; women.

Figure 1

Proportion of high cumulative biological risk (CBR)† score by age and sex. †High CBR was defined as at least 1 SD above the mean score. *P<0.01 and **p<0.001 comparing sex differences within each age group.

Figure 2

Neighbourhood clustering (intraclass correlation coefficient [ICC] %) of high cumulative biological risk (CBR)* by individual biomarkers** and sex. CBR, cumulative biological risk; DBP, diastolic blood pressure; SBP, systolic blood pressure; WC, waist circumference; TC, total cholesterol; FBG, fasting blood glucose; BMI, body mass index. *High CBR was defined as at least one SD above the mean score. **Individual biomarkers were included based on high risk cut-points: Self-reported asthma, DBP > 85 mm Hg, SBP > 130 mm Hg, WC > 85 mm Hg, TC > 5.7 mM/L, FBG ≥ 110 mg/dL and BMI ≥ 25 kg/m²; for youth <18 years old high-risk cut-points used were > one SD above the mean for their age and sex or ≥ the adult high risk cut-point value, except for SBP and DBP, with high risk cut-points defined as being greater than or equal to the 94th percentile for age, sex and BMI.