Longitudinal profiles of neighborhood socioeconomic vulnerability influence blood pressure changes across the female midlife period

Abstract

Purpose: To examine whether longitudinal exposure to neighborhood socioeconomic vulnerability influences blood pressure changes throughout midlife in a racially, ethnically, and geographically-diverse cohort of women transitioning through menopause.

Methods: We used longitudinal data on 2738 women (age 42-52 at baseline) living in six United States cities from The Study of Women's Health Across the Nation. Residential histories, systolic blood pressures (SBP), and diastolic blood pressures (DBP) were collected annually for ten years. We used longitudinal latent profile analysis to identify patterns of neighborhood socioeconomic vulnerability occurring from 1996 to 2007 in participant neighborhoods. We used linear mixed-effect models to determine if a woman's neighborhood profile throughout midlife was associated with blood pressure changes.

Results: We identified four unique profiles of neighborhood socioeconomic vulnerability - differentiated by residential socioeconomic status, population density, and vacant housing conditions - which remained stable across time. Women residing in the most socioeconomically vulnerable neighborhoods experienced the steepest increase in annual SBP growth by 0.93 mmHg/year (95% CI: 0.65-1.21) across ten-year follow-up.

Conclusions: Neighborhood socioeconomic vulnerability was significantly associated with accelerated SBP increases throughout midlife among women.

Keywords: Blood pressure; Epidemiology; Health disparities; Hypertension; Midlife; Neighborhood.

Figure 1.

Longitudinal latent profile characteristics of neighborhoods over time, by census indicator variable: the Study of Women’s Health Across the Nation, United States, 1996–2007 (n=1,074 census tracts).

Figure 2.

Latent profile characteristics of SWAN neighborhoods at year 2000, by census indicator variables^a: the Study of Women’s Health Across the Nation, United States (n=1,074 census tracts). Abbreviations: VL, Very Low; L, Low; ML, Moderately Low; A, Average; MH, Moderately High; H, High; VH, Very High; ^aLevels, indicating degree of presence in neighborhood, correspond to the following indicator z-score values: Very Low (z <= −1); Low (−1 < z <= −0.5); Moderately Low (−0.5 < z <= −0.1); Average (−0.1 < z < 0.1); Moderately High (0.1 <= z < 0.5); High (0.5 <= z < 1); Very High (z >= 1)

Figure 3.

Trajectories of systolic blood pressure change (mmHg) per latent neighborhood profile of residence throughout midlife^a (n=2,738 women; n=16,911 observations): the Study of Women’s Health Across the Nation, United States (1996–2007). Abbreviations: SBP, systolic blood pressure; CI, confidence interval; ^aPredicted mean SBP levels (mmHg), and annual rates of SBP change (95% CI), by latent neighborhood profile of residence throughout midlife, as estimated from linear mixed-effect models adjusted for baseline age, race/ethnicity, site, education level, marital status, employment status, alcohol use, current smoking, depressive symptoms, physical activity score, menopausal status, ever use of hormone therapy, and obesity. Note: SWAN visits V00-V10 were conducted at approximately yearly intervals starting in 1996 at baseline (V00) through ten-year follow-up (V10).

Figure 4.

Trajectories of diastolic blood pressure change (mmHg) per latent neighborhood profile of residence throughout midlife^a (n=2,736 women, n=16,900 observations): the Study of Women’s Health Across the Nation, United States (1996–2007). Abbreviations: DBP, diastolic blood pressure; CI, confidence interval; ^aPredicted mean DBP levels (mmHg), and annual rates of DBP change (95% CI), by latent neighborhood profile of residence throughout midlife, as estimated from linear mixed-effect models adjusted for baseline age, race/ethnicity, site, education level, marital status, employment status, alcohol use, current smoking, depressive symptoms, physical activity score, menopausal status, ever use of hormone therapy, and obesity. Note: SWAN visits V00-V10 were conducted at approximately yearly intervals starting in 1996 at baseline (V00) through ten-year follow-up (V10).