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Original research
Association between spatial social polarisation and high blood pressure in older adults
  1. Hoda S. Abdel Magid1,
  2. Samuel Jaros2,
  3. Gina S. Lovasi3,
  4. Andrea L. Rosso4,
  5. Annabel X. Tan5,
  6. David H. Rehkopf5,
  7. Lorene M. Nelson5,
  8. Michelle Carlson6,
  9. Suzanne E. Judd7,
  10. Michelle C. Odden5
  1. 1Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
  2. 2Epidemiology and Community Health, Stanford University, Stanford, California, USA
  3. 3Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania, USA
  4. 4University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  5. 5Department of Epidemiology and Population Health, Stanford University, Stanford, California, USA
  6. 6Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
  7. 7School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
  1. Correspondence to Dr Hoda S. Abdel Magid; hmagid{at}usc.edu

Abstract

Background Using data from the Cardiovascular Health Study (CHS) and the REasons for Geographic And Racial Differences in Stroke (REGARDS) study, we investigate the association between socioeconomic polarisation and blood pressure outcomes in black and white adults. We also validate previous findings that joint racial/ethnic and income measures of spatial social polarisation (SSP) outperform single domain measures.

Methods We conducted a cross-sectional analysis using a retrospective cohort combining CHS (recruited 1989–1990 and 1992–1993) and REGARDS (recruited 2003–2007). The study included 5888 CHS participants aged ≥65 years and 30 183 REGARDS participants aged ≥45 years. SSP was measured using the Index of Concentration at the Extremes for education, race/ethnicity, income, home ownership, and joint race/ethnicity and income at ZIP code, census tract and county levels. The SSP measures were modelled against the presence of high blood pressure and systolic blood pressure.

Results The sample had a mean age of 66 (SD: 9), was majority female (56%), white/other (63%), and at least high school graduates (85%). A total of 26% had high blood pressure, with a mean systolic blood pressure of 129 mm Hg (SD: 18). Census tract-level models showed low-income black areas had 25% (95% CI 11%–40%) higher odds of high blood pressure and 1.8 mm Hg (95% CI 1.0–2.5) higher mean systolic blood pressure than high-income White areas.

Conclusion Greater SSP is associated with a higher risk of high blood pressure and higher systolic blood pressure. Further investigating and reducing polarisation could help mitigate cardiovascular health disparities, improving outcomes for socioeconomically deprived communities.

  • BLOOD PRESSURE
  • SPATIAL ANALYSIS
  • SOCIAL SCIENCES

Data availability statement

No data are available.

https://doi.org/10.1136/jech-2024-223191

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    Data availability statement

    No data are available.

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    Footnotes

    • HSAM and SJ are joint first authors.

    • X @GinaLovasi, @drehkopf

    • Contributors HSAM is the guarantor. HSAM conceptualised the study, secured funding and oversaw project administration. SJaros led the data analysis and statistical modelling. MCO supervised the research design and provided methodological guidance. MCO, GSL, ALR, AXT, DR, LMN, MC and SJudd contributed to the interpretation of results and refinement of the manuscript. All authors critically reviewed and revised the manuscript for intellectual content. HSAM is the guarantor, responsible for the overall content and integrity of the work.

    • Funding HSAM is supported by the National Heart, Lung, and Blood Institute (R00HL161479). SJaros is supported by the National Institute on Drug Abuse (F31DA057107). GSL is supported by the National Institute on Aging (R56AG049970). LMN is supported by the National Institute of Neurological Disorders and Stroke (U01NS038455), the National Center for Advancing Translational Sciences (UL1TR003142), the National Heart, Lung, and Blood Institute (T32HL151323), UCB Biopharma (not applicable), the Lawrence Livermore National Laboratory (not applicable) and Congressionally Directed Medical Research Programmes (B659350). SJudd is supported by the National Institute of Neurological Disorders and Stroke and the National Institute on Aging (U01NS041588). The Cardiovascular Health Study (CHS) is supported by contracts HHSN268201200036C, HHSN268200800007C, HHSN268201800001C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086 and 75N92021D00006; the National Heart, Lung, and Blood Institute (U01HL080295, U01HL130114); the National Institute of Neurological Disorders and Stroke; and the National Institute on Aging (R01AG023629). A full list of principal CHS investigators and institutions can be found at chs-nhlbi.org. The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study is supported by the National Institute of Neurological Disorders and Stroke and the National Institute on Aging (U01NS041588). A full list of participating REGARDS investigators and institutions can be found at uab.edu/soph/regardsstudy. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders. Representatives of the CHS and REGARDS studies were involved in the review of the manuscript but were not directly involved in the collection, management, analysis or interpretation of the data.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.