Identification of Resilient and At-Risk Neighborhoods for Cardiovascular Disease Among Black Residents: the Morehouse-Emory Cardiovascular (MECA) Center for Health Equity Study

• Authors: Jeong Hwan Kim, Emory University; Tene T. Lewis, Emory University; Matthew L. Topel, Emory University; Mohamed Mubasher, Morehouse School of Medicine; Chaohua Li, Morehouse School of Medicine; Viola Vaccarino, Emory University; Mahasin S. Mujahid, University of California Berkeley; Mario Sims, University of Mississippi; Arshed Ali Quyyumi, Emory University; Herman A. Taylor, Emory University; Peter T. Baltrus, Morehouse School of Medicine
• Journal Title: Preventing Chronic Disease
• Volume: Volume 16, Number 5
• Publisher: Centers for Disease Control and Prevention | 2019-05-01, Pages E57-E57
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.5888/pcd16.180505
• Subjects: Health Sciences, Public Health; Health Sciences, Epidemiology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Public, Environmental & Occupational Health; CORONARY-HEART-DISEASE; INCOME INEQUALITY; MORTALITY; ENVIRONMENTS; DEPRIVATION; AREAS

Abstract

Introduction Despite the growing interest in place as a determinant of health, areas that promote rather than reduce cardiovascular disease (CVD) in blacks are understudied. We performed an ecologic analysis to identify areas with high levels of CVD resilience and risk among blacks from a large southern, US metropolitan area. Methods We obtained census tract-level rates of cardiovascular deaths, emergency department (ED) visits, and hospitalizations for black adults aged 35 to 64 from 2010 through 2014 for the Atlanta, Georgia, metropolitan area. Census tracts with substantially lower rates of cardiovascular events on the basis of neighborhood socioeconomic status were identified as resilient and those with higher rates were identified as at risk. Logistic regression was used to estimate the odds ratios (OR) and 95% confidence intervals (CIs) of being classified as an at-risk versus resilient tract for differences in census-derived measures. Results We identified 106 resilient and 121 at-risk census tracts, which differed in the rates per 5,000 person years of cardiovascular outcomes (mortality, 8.13 vs 13.81; ED visits, 32.25 vs 146.3; hospitalizations, 26.69 vs 130.0), despite similarities in their median black income ($46,123 vs $ 45,306). Tracts with a higher percentage of residents aged 65 or older (odds ratio [OR], 2.29; 95% CI, 1.41-3.85 per 5% increment) and those with incomes less than 200% of the federal poverty level (OR, 1.19; 95% CI, 1.02-1.39 per 5% increment) and greater Gini index (OR, 1.56; 95% CI, 1.19- 2.07 per 0.05 increment) were more likely to be classified as at risk than resilient neighborhoods. Discussion Despite matching on median income level, at-risk neighborhoods for CVD among black populations were associated with a higher prevalence of socioeconomic indicators of inequality than resilient neighborhoods.