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Neighborhood Socioeconomic Factors and Cardiovascular Disease: a Cluster Analysis in North Carolina
Citation:
Weaver, A., L. McGuinn, L. Neas, R. Devlin, R. Dhingra, C. Ward-Caviness, W. Cascio, W. Kraus, E. Hauser, AND D. Diaz-Sanchez. Neighborhood Socioeconomic Factors and Cardiovascular Disease: a Cluster Analysis in North Carolina. International Society for Environmental Epidemiology (ISEE), Otttawa, Ontario, CANADA, August 26 - 30, 2018.
Impact/Purpose:
Neighborhood socioeconomic status (SES) is associated with life expectancy and health outcomes, including cardiovascular disease (CVD) and diabetes. We studied the effects of neighborhood SES on CVD and diabetes among 6992 patients who underwent cardiac catheterization 2001-2010 at Duke University and lived in North Carolina. We assigned patients to one of 8 possible clusters based on area-level factors including urbanicity, race, and SES indicators. We observed differences in odds of CVD and diabetes based on neighborhood SES. Specifically, an urban cluster with a large black population and low SES had increased odds of hypertension and the wealthiest urban cluster had reduced odds of diabetes. A rural cluster with a large black population and low SES had increased odds of diabetes, hypertension, and coronary artery disease, while a rural cluster with a large American Indian population had increased odds of coronary artery disease. These results are informative for future studies of health disparities among large and diverse populations that include participants of different races, living in urban and rural areas with varying SES.
Description:
Where we live contributes to how long and how well we live. Neighborhood-level socioeconomic status (SES) is associated with health outcomes, including cardiovascular disease (CVD) and diabetes, but these associations are rarely studied across large, diverse populations. We used Ward’s Hierarchical clustering to define 8 neighborhood SES clusters across North Carolina (NC) using 11 Census variables, including indicators of education, race, wealth, and urbanicity. Then, we assigned 6992 cardiac catheterization patients at Duke University to neighborhood clusters. We examined the associations between cluster and coronary artery disease index >23 (CAD) at the time of the index visit as determined at coronary catheterization, hypertension, and diabetes using logistic regression adjusted for age, race, sex, body mass index, and smoking status. Four clusters were urban, 3 were rural, and the referent cluster was suburban. Compared to the suburban cluster, an urban cluster with low SES and large Black populations had 40% increased odds of hypertension (95% CI 1.07-1.85), while the highest SES urban cluster had lower odds of diabetes (OR 0.72, 95% CI 0.57, 0.92). A rural cluster with low SES and high % black, had higher odds of all outcomes (OR for diabetes 1.25, 95% CI 1.03-1.53; for hypertension 1.28, 95% CI 1.05-1.56; for CAD 1.39, 95% CI 1.15-1.69). In addition, a rural cluster with low SES and a large American Indian population had increased odds of CAD (OR 1.70, 95% CI 1.20, 2.41). We observed differences in prevalence of CVD and diabetes across NC based on neighborhood characteristics. This study has implications for future studies among diverse populations and contributes to understanding of the total environment. This abstract does not necessarily reflect EPA policy.