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Article
Association of Changes in Neighborhood-Level Racial Residential Segregation With Changes in Blood Pressure Among Black Adults: The CARDIA Study
University of Massachusetts Medical School Faculty Publications
  • Kiarri N. Kershaw, Northwestern University
  • Whitney R. Robinson, University of North Carolina Gillings School of Public Health
  • Penny Gordon-Larsen, University of North Carolina
  • Margaret T. Hicken, University of Michigan, Ann Arbor
  • David C. Goff, Colorado School of Public Health
  • Mercedes R. Carnethon, Northwestern University
  • Catarina I. Kiefe, University of Massachusetts Medical School
  • Stephen Sidney, Kaiser Permanente Northern California
  • Ana V. Diez Roux, Drexel University Dornsife School of Public Health
UMMS Affiliation
Department of Quantitative Health Sciences
Date
5-15-2017
Document Type
Article
Abstract
Importance: Despite cross-sectional evidence linking racial residential segregation to hypertension prevalence among non-Hispanic blacks, it remains unclear how changes in exposure to neighborhood segregation may be associated with changes in blood pressure. Objective: To examine the association of changes in neighborhood-level racial residential segregation with changes in systolic and diastolic blood pressure over a 25-year period. Design, Setting, and Participants: This observational study examined longitudinal data of 2280 black participants of the Coronary Artery Risk Development in Young Adults (CARDIA) study, a prospective investigation of adults aged 18 to 30 years who underwent baseline examinations in field centers in 4 US locations from March 25, 1985, to June 7, 1986, and then were re-examined for the next 25 years. Racial residential segregation was assessed using the Getis-Ord Gi* statistic, a measure of SD between the neighborhood's racial composition (ie, percentage of black residents) and the surrounding area's racial composition. Segregation was categorized as high (Gi* > 1.96), medium (Gi* 0-1.96), and low (Gi* < 0). Fixed-effects linear regression modeling was used to estimate the associations of within-person change in exposure to segregation and within-person change in blood pressure while tightly controlling for time-invariant confounders. Data analyses were performed between August 4, 2016, and February 9, 2017. Main Outcomes and Measures: Within-person changes in systolic and diastolic blood pressure across 6 examinations over 25 years. Results: Of the 2280 participants at baseline, 974 (42.7%) were men and 1306 (57.3%) were women. Of these, 1861 (81.6%) were living in a high-segregation neighborhood; 278 (12.2%), a medium-segregation neighborhood; and 141 (6.2%), a low-segregation neighborhood. Systolic blood pressure increased by a mean of 0.16 (95% CI, 0.06-0.26) mm Hg with each 1-SD increase in segregation score after adjusting for interactions of time with age, sex, and field center. Of the 1861 participants (81.6%) who lived in high-segregation neighborhoods at baseline, reductions in exposure to segregation were associated with reductions in systolic blood pressure. Mean differences in systolic blood pressure were -1.33 (95% CI, -2.26 to -0.40) mm Hg when comparing high-segregation with medium-segregation neighborhoods and -1.19 (95% CI, -2.08 to -0.31) mm Hg when comparing high-segregation with low-segregation neighborhoods after adjustment for time and interactions of time with baseline age, sex, and field center. Changes in segregation were not associated with changes in diastolic blood pressure. Conclusions and Relevance: Decreases in exposure to racial residential segregation are associated with reductions in systolic blood pressure. This study adds to the small but growing body of evidence that policies that reduce segregation may have meaningful health benefits.
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Publisher PDF posted after 6 months as allowed by the publisher's author rights policy at http://jamanetwork.com/journals/jamainternalmedicine/pages/instructions-for-authors#SecDepositingResearchArticlesinApprovedPublicRepositories. Citation: JAMA Intern Med. 2017 May 15. doi: 10.1001/jamainternmed.2017.1226. Link to article on publisher's site
Related Resources
Link to Article in PubMed
Keywords
  • Racial residential segregation,
  • neighborhoods,
  • blood pressure
PubMed ID
28505341
Citation Information
Kiarri N. Kershaw, Whitney R. Robinson, Penny Gordon-Larsen, Margaret T. Hicken, et al.. "Association of Changes in Neighborhood-Level Racial Residential Segregation With Changes in Blood Pressure Among Black Adults: The CARDIA Study" (2017) ISSN: 2168-6106 (Linking)
Available at: http://works.bepress.com/catarina_kiefe/265/