Association Found Between Neighborhood Deprivation, Hypertension

Neighborhood deprivation and hypertension prevalence were found to have an association with each other, according to a study published in JAMA Network Open.¹ The study found that disparities were most prominent in Black patients, leading the authors to call for improvements in community health.

Hypertension affects approximately 119.9 million adults living in the US, with about 1 in 4 adults having their hypertension under control.² Hypertension also acts as a risk factor for cardiovascular disease, with a decrease in blood pressure by at least 10 mm Hg estimated to reduce the risk between 20% and 30%. Uncontrolled hypertension in non-Hispanic Black patients contributes to disparities in cardiovascular disease, stroke, and mortality. Noting that historic redlining has kept Black patients in areas of disinvestment, this study's researchers aimed to assess the association of neighborhood socioeconomic position and racial and ethnic composition with spatial patterns in the diagnosis of hypertension.¹

Hypertension is associated with neighborhood deprivation and access to resources | Image credit: © Andrey Popov - stock.adobe.com

Data from an electronic health record (EHR) for patients aged 35 to 50 years living in Cuyahoga County in Ohio were collected for the cross-sectional study. All patients had at least 1 primary care appointment in 2019 in the Cleveland Clinic Health System or MetroHealth System. Area deprivation index (ADI) data were collected from the 2015 to 2019 American Community Survey 5-year data. This included education, housing, income, and occupation measures. Clinical diagnosis of essential hypertension was the primary outcome of the study.

Address at the time of the primary care visit was used to group patients into neighborhoods. The percentage of Black patients living in each neighborhood was calculated and the EHR provided the race and ethnicity of each patient, along with their sex and age. Comorbidities and body mass index were also collected.

There were 56,387 adults included in this study who all lived in 1157 neighborhoods. The median (IQR) age was 43.1 (39.1-46.9) years and 59.8% were women. A total of 21.6% of the patients lived in the ADI quintile with the least resources whereas 31.2% lived in the ADI quintile with the most. Participants who identified as Black made up 31.1% of the participants, Asian participants made up 3.4%, Hispanic patients made up 5.5%, and White patients made up 60.0%.

The lowest ADI quintile, which had the most resources, was made up of 86.1% White patients and 7.0% Black patients, whereas the highest ADI quintile, which had the least amount of resources, had 61.2% Black patients and 24.6% White patients. A higher prevalence of hypertension (50.7% vs 25.5%) and lower treatment rates (61.3% vs 64.5%) were found in the highest ADI quintile compared with the lowest quintile. All men had a higher prevalence of hypertension compared with women, but Black patients had the smallest difference in prevalence between men and women, and Black men and women had the highest prevalence of hypertension compared with other ethnic groups (men, 56.5%; women, 51.4%).

A higher ADI quintile was associated with higher neighborhood-level prevalence of hypertension (r = 0.73). A higher ADI score was also associated with neighborhoods with a greater percentage of Black patients (r = 0.62). There were 200 neighborhoods that had hypertension rates that were higher than 35% and had a less than 70% rate of antihypertensive prescriptions, with 80% of the 200 neighborhoods being in the highest ADI quintile. There were only 31 neighborhoods where Black patients made up 5% or less of the population that had hypertension rates that were greater than 35% with less than 70% treatment rate.

When using a conditional autoregressive Poisson rate model, a 58% increased risk of hypertension was found in men living in the highest ADI quintile compared with the lowest quintile (posterior mean, 1.58; 95% CI, 1.46-1.70). Hypertension was twice as prevalent in the highest ADI quintile compared with the lowest (posterior mean, 2.08; 95% CI, 1.91-2.25). An interaction analysis that included a 3-way interaction between sex, race, and ethnicity found that the odds of hypertension in the highest vs lowest quintile was highest in White men (OR, 1.77; 95% CI, 1.57-2.00) and White women (OR, 2.88; 95% CI, 2.58-3.21) when compared with Black men (OR, 1.46; 95% CI, 1.20-1.77) and Black women (OR, 1.68; 95% CI, 1.44-1.96).

There were some limitations to this study. Only people who use the health care system were included in this study, which could underestimate the number of people with hypertension. It is unknown if the patients who were prescribed antihypertension medicine were actively taking the medication for hypertension, as they can be used for other conditions. It is possible that a third party provided the race and ethnicity data, despite their description as self-reported. Generalizability may be limited due to the study only covering 1 county in the US.

The researchers concluded that racial and neighborhood disparities exist in hypertension treatment and prevalence, specifically in adults aged 35 to 50 years. Future research should focus on identifying neighborhoods that need more attention to minimize the effects of hypertension in the areas.

References

1. Blazel MM, Perzynski AT, Gunsalus PR, et al. Neighborhood-level disparities in hypertension prevalence and treatment among middle-aged adults. JAMA Netw Open. 2024;7(8):e2429764. doi:10.1001/jamanetworkopen.2024.29764
2. Estimated hypertension prevalence, treatment, and control among U.S. adults. Million Hearts. Updated May 12, 2023. Accessed August 22, 2024. https://millionhearts.hhs.gov/data-reports/hypertension-prevalence.html