Cardiovascular health among Black adults in the United States is impacted by neighborhood factors such as safety, physical and social environments, and the lived individual experiences of discrimination, according to findings from a study in JAMA Network Open.
The study utilized data from Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, focusing on participants who completed a second in-home visit between 2013 and 2016. In total, 7,720 participants were included. Participants were at least 45 years at baseline (2003-2007), and the mean age during the analysis period was 71.9 years. Fifty-seven percent of participants were women; 27% were Black and 73.1% were White. Exposures included:
- neighborhood physical environment, such as excessive noise and violence
- neighborhood safety
- neighborhood social cohesion, such as shared values
- perceived stress
- experiences of discrimination
The presence of exposures was compared with participants’ cardiovascular health. Ideal cardiovascular health (ICH) was measured as a composite of 4 health behaviors (cigarette smoking, diet, physical activity, body mass index) and 3 health factors (blood pressure, cholesterol, and glucose levels).
Racial Differences in Health Outcomes
Overall, Black participants reported higher perceived stress than their White counterparts (rating out of 16: 3.2 vs 2.8, respectively), and Black adults were more likely to report experiencing discrimination than White adults (77.0% vs 24.0%, respectively). Neighborhood physical environment was also rated lower by Black participants, as well as lower levels of neighborhood social cohesion. Black participants reported that their neighborhoods were unsafe more often than White participants (54.7% vs 24.3%).
Regarding heart health outcomes, the odds of having a high total ICH score were lower for Black versus White participants overall (adjusted odds ratio [AOR], 0.53; 95% confidence interval [CI], 0.45-0.61). This relationship was also found when stratified by gender: the AOR for a high ICH score for Black men was 0.73 (95% CI, 0.57-0.93), and for Black women was 0.45 (95% CI, 0.37-0.54).
Relationship With Gender
The authors noted that in mediation analyses, the racial disparity in total ICH score was attenuated by neighborhood physical environment (5.14%), neighborhood safety (6.27%), neighborhood social cohesion (1.41%), and discrimination (11.01%). Stratified analyses showed that neighborhood safety was the factor that most greatly attenuated the racial disparity in ICH scores among men (12.32%).
“Of note, social cohesion helped to explain racial differences in ICH among men only,” the authors commented. “This finding suggests that neighborhood social conditions constituting a more communal level of social support rather than solely that of the familial level may help to counter some of the stress faced by Black men, with implications for improved ICH.”
For women, the greatest attenuating factor for the racial disparity in heart health outcomes was discrimination (14.37%). “One category of unique discrimination experiences by Black women—gendered racial microaggressions—has been associated with poorer mental health and self-reported health. Additional studies are required to understand the role of these unique discrimination experiences in cardiovascular health,” the authors wrote.
Overall, “Further work is needed to explore these associations in other diverse populations, particularly differential associations between discrimination and ICH by gender. From a public health standpoint, these data suggest that interventional approaches that separately target neighborhood factors and discrimination by gender and race are warranted,” the authors concluded.