The impact of social context on cardiovascular risk: Moderators and mediators of the relation of neighborhood disorder and cardiovascular risk factors

Abstract

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in the United States, and there are known disparities in the incidence and prevalence of clinical CVD endpoints and specific CVD risk factors. Elucidating the causes of these disparities is an important step in reducing their impact, and a growing literature has identified neighborhood context as a potential explanation for cardiovascular health inequities. Residing in a neighborhood characterized by disadvantage or physical and social disorder has been associated with increased cardiovascular risk. However, the methodology of this literature varies widely, and there is a paucity of evidence for moderators and mediators of this relation. The present investigation addressed this gap by examining whether the relation between perceived neighborhood disorder (ND) and specific cardiovascular risk factors (resting blood pressure, body mass index [BMI], cholesterol, glycated hemoglobin) is moderated by race and sex and mediated by negative affect. Participants were 1,498 adults (mean age = 48.2 years, SD = 9.22 years; 56.3% women; 56.2% African American [AA], 39.5% below the 125% poverty line) in the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) study. During a comprehensive medical examination, CVD risk factors were assessed and participants completed measures of perceived ND (e.g. abandoned buildings, graffiti, litter, crime, gang activity, drug trade, etc.) and negative affect (depressive, anxious, or post-trauma stress symptoms, anger, perceived stress). One negative affect component was extracted via principal components analysis. Multivariable regression analyses were adjusted for demographics, perceived healthcare barriers, biomedical risk, medication use, and substance use. Results revealed that greater perceived ND was associated with elevated risk (higher BMI) among women and whites and lower risk (lower BMI, cholesterol, HbA1c) among AAs. Negative affect did not mediate these relations. These results revealed that race and sex may moderate the relation of neighborhood context and CVD risk. Negative affect did not mediate this relation, which suggests a need for additional research to elucidate mechanistic pathways. In light of racial residential segregation in the U.S., these results highlight the importance of considering relations between neighborhood, social, and individual factors when studying CVD risk.