title: A novel approach for measuring residential socioeconomic factors associated with cardiovascular and metabolic health.
abstract: Individual-level characteristics, including socioeconomic status, have been associated with poor metabolic and cardiovascular health; however, residential area-level characteristics may also independently contribute to health status. In the current study, we used hierarchical clustering to aggregate 444 US Census block groups in Durham, Orange, and Wake Counties, NC, USA into six homogeneous clusters of similar characteristics based on 12 demographic factors. We assigned 2254 cardiac catheterization patients to these clusters based on residence at first catheterization. After controlling for individual age, sex, smoking status, and race, there were elevated odds of patients being obese (odds ratio (OR)=1.92, 95% confidence intervals (CI)=1.39, 2.67), and having diabetes (OR=2.19, 95% CI=1.57, 3.04), congestive heart failure (OR=1.99, 95% CI=1.39, 2.83), and hypertension (OR=2.05, 95% CI=1.38, 3.11) in a cluster that was urban, impoverished, and unemployed, compared with a cluster that was urban with a low percentage of people that were impoverished or unemployed. Our findings demonstrate the feasibility of applying hierarchical clustering to an assessment of area-level characteristics and that living in impoverished, urban residential clusters may have an adverse impact on health.
authors.affiliation: Curriculum in Toxicology, University of North Carolina, Chapel Hill, North Carolina, USA.|Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: Jaime E
authors.initials: JE
authors.lastname: Mirowsky
authors.affiliation: National Health and Environmental Effects Laboratory, US Environmental Protection Agency, Chapel Hill, North Carolina, USA.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Devlin
authors.affiliation: National Health and Environmental Effects Laboratory, US Environmental Protection Agency, Chapel Hill, North Carolina, USA.
authors.forename: David
authors.initials: D
authors.lastname: Diaz-Sanchez
authors.affiliation: National Health and Environmental Effects Laboratory, US Environmental Protection Agency, Chapel Hill, North Carolina, USA.
authors.forename: Wayne
authors.initials: W
authors.lastname: Cascio
authors.affiliation: National Health and Environmental Effects Laboratory, US Environmental Protection Agency, Chapel Hill, North Carolina, USA.
authors.forename: Shannon C
authors.initials: SC
authors.lastname: Grabich
authors.affiliation: Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Carol
authors.initials: C
authors.lastname: Haynes
authors.affiliation: Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Colette
authors.initials: C
authors.lastname: Blach
authors.affiliation: Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina, USA.|Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, USA.|Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Hauser
authors.affiliation: Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina, USA.|Division of Cardiology, Department of Medicine, School of Medicine, Duke University, Durham, North Carolina, USA.
authors.forename: Svati
authors.initials: S
authors.lastname: Shah
authors.affiliation: Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina, USA.|Division of Cardiology, Department of Medicine, School of Medicine, Duke University, Durham, North Carolina, USA.
authors.forename: William
authors.initials: W
authors.lastname: Kraus
authors.affiliation: National Center for Environmental Assessment, US Environmental Protection Agency, Chapel Hill, North Carolina, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Olden
authors.affiliation: National Health and Environmental Effects Laboratory, US Environmental Protection Agency, Chapel Hill, North Carolina, USA.
authors.forename: Lucas
authors.initials: L
authors.lastname: Neas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization; D002318:Cardiovascular Diseases / Q000453:epidemiology; D019352:Censuses; D016000:Cluster Analysis; D015331:Cohort Studies; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006304:Health Status; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D008297:Male; D008659:Metabolic Diseases / Q000453:epidemiology; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology; D011203:Poverty; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012307:Risk Factors; D012424:Rural Population; D012907:Smoking; D012923:Social Class; D012959:Socioeconomic Factors; D014505:Urban Population; D055815:Young Adult