Neighborhood stressors and race/ethnic differences in hypertension prevalence (the Multi-Ethnic Study of Atherosclerosis).
BACKGROUND
The reasons for racial/ethnic disparities in hypertension (HTN) prevalence in the United States are poorly understood.


METHODS
Using data from the Multi-Ethnic Study of Atherosclerosis (MESA), we investigated whether individual- and neighborhood-level chronic stressors contribute to these disparities in cross-sectional analyses. The sample consisted of 2,679 MESA participants (45-84 years) residing in Baltimore, New York, and North Carolina. HTN was defined as systolic or diastolic blood pressure ≥140 or 90 mm Hg, or taking antihypertensive medications. Individual-level chronic stress was measured by self-reported chronic burden and perceived major and everyday discrimination. A measure of neighborhood (census tract) chronic stressors (i.e., physical disorder, violence) was developed using data from a telephone survey conducted with other residents of MESA neighborhoods. Binomial regression was used to estimate associations between HTN and race/ethnicity before and after adjustment for individual and neighborhood stressors.


RESULTS
The prevalence of HTN was 59.5% in African Americans (AAs), 43.9% in Hispanics, and 42.0% in whites. Age- and sex-adjusted relative prevalences of HTN (compared to whites) were 1.30 (95% confidence interval (CI): 1.22-1.38) for AA and 1.16 (95% CI: 1.04-1.31) for Hispanics. Adjustment for neighborhood stressors reduced these to 1.17 (95% CI: 1.11-1.22) and 1.09 (95% CI: 1.00-1.18), respectively. Additional adjustment for individual-level stressors, acculturation, income, education, and other neighborhood features only slightly reduced these associations.


CONCLUSIONS
Neighborhood chronic stressors may contribute to race/ethnic differences in HTN prevalence in the United States.
Mujahid
Mahasin S
MS
University of California, Berkeley, USA. mmujahid@berkeley.edu
Diez Roux
Ana V
AV
Cooper
Richard C
RC
Shea
Steven
S
Williams
David R
DR
D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D050197:Atherosclerosis / Q000208:ethnology* / Q000503:physiopathology / Q000523:psychology; D001794:Blood Pressure; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D054624:Health Status Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000208:ethnology* / Q000503:physiopathology / Q000523:psychology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011287:Prejudice; D015995:Prevalence; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors; D013315:Stress, Psychological; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*
D000959:Antihypertensive Agents