The Geographic Context and Black-White Disparities in Hypertension.

This dissertation evaluated the contribution of the geographic context to black-white disparities in hypertension. Few studies of area-level factors and hypertension disparities have focused on geographic variation both within and between race groups. Uncovering the mechanisms underlying within-group variation may help elucidate the particular environmental factors that contribute to hypertension disparities and highlight potential targets for interventions. Understanding how the distribution of high blood pressure compares for Blacks versus Whites across different environments helps shed light on the mutability of the disparity and potential ways in which it can be reduced. The studies in this dissertation investigated (1) regional geographic factors related to hypertension differences among and between Blacks and Whites; (2) the association between metropolitan-level racial residential segregation and hypertension and neighborhood poverty as a mediating pathway; and (3) the link between neighborhood-level racial residential segregation and hypertension and interactions with area- and individual-level factors. The key finding was that race differences are not invariant. Hypertension prevalence varied significantly within race groups and race differences in hypertension were modified by context. Blacks and Whites born in the South and those living in metropolitan areas located in the South were more likely to be hypertensive than those born or living in other parts of the country. Blacks living in more segregated metropolitan areas had significantly higher odds of hypertension than those in less segregated areas, and the impact of segregation varied by metropolitan area and neighborhood poverty. Race differences in hypertension prevalence ranged from 82% higher for Blacks versus Whites to a low of 13% higher depending on which geographic groups were compared. Race differences also varied significantly by metropolitan-level segregation and neighborhood poverty; in high segregation, low poverty areas Blacks had over 4 times higher odds of hypertension versus Whites whereas Blacks in low segregation, high poverty areas had just 1.2 times higher odds. These findings suggest that race differences in hypertension result not from innate differences but from contextual factors. Specifically, eliminating the processes that lead to residential segregation and the resultant inequitable distribution of neighborhood resources could reduce the unequal burden of hypertension in Blacks versus Whites.PhDEpidemiological ScienceUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/78734/1/kkershaw_1.pd

Metropolitan-level ethnic residential segregation, racial identity, and body mass index among U.S. Hispanic adults: a multilevel cross-sectional study

Abstract Background The few studies that have examined whether metropolitan-level ethnic residential segregation is associated with obesity among Hispanics are mixed. The segmented assimilation theory, which suggests patterns of integration for immigrant groups varies by social factors, may provide an explanation for these mixed findings. In this study we examined whether one social factor, racial identity, modified the association between ethnic residential segregation and body mass index (BMI) among Hispanics. Methods We used data on 22,901 male and 37,335 non-pregnant female Hispanic adult participants of the 2003–2008 U.S. Behavioral Risk Factor Surveillance System living in 227 metropolitan or micropolitan areas (MMSAs). Participants self-identified as White, Black, and ‘some other race’. BMI was calculated using self-reported height and weight; the Hispanic isolation index was used to measure Hispanic residential segregation. Using multi-level linear regression models, we examined the association of Hispanic residential segregation with BMI, and we investigated whether this relationship varied by race. Results Among men, Hispanic segregation was unassociated with BMI after adjusting for age, race, MMSA-level poverty, and MMSA-level population size; there was no variation in this relationship by race. Among women, significant associations between Hispanic segregation and BMI in models adjusted for demographics and MMSA-level confounders became attenuated with further adjustment for education and language of exam. However, there was statistically significant variation by race (P interaction = 0.03 and 0.09 for Hispanic Blacks and Hispanics who identified as some other race, respectively, vs. Hispanic Whites). Specifically, higher segregation was associated with higher mean BMI among Hispanic Whites, but it was associated with lower mean BMI among Hispanic Blacks. Segregation was unassociated with BMI among Hispanic women identifying as some other race. Conclusions This heterogeneity highlights the persistent influence of race on structural processes that can have downstream consequences on health. As Hispanics grow as a proportion of the U.S. population, especially across urban centers, understanding the health consequences of residence in segregated areas, and whether or not these impacts vary across different groups, will be important for the design of more comprehensive solutions to prevent adverse health outcomes

County-Level Hispanic Ethnic Density and Cardiovascular Disease Mortality.

Background Hispanics are the fastest growing ethnic group in the United States, and little is known about how Hispanic ethnic population density impacts cardiovascular disease ( CVD ) mortality. Methods and Results We examined county-level deaths for Hispanics and non-Hispanic whites from 2003 to 2012 using data from the National Center for Health Statistics' Multiple Cause of Death mortality files. Counties with more than 20 Hispanic deaths (n=715) were included in the analyses. CVD deaths were identified using International Classification of Diseases, Tenth Revision (ICD-10), I00 to I78, and population estimates were calculated using linear interpolation from 2000 and 2010 census data. Multivariate linear regression was used to examine the association of Hispanic ethnic density with Hispanic and non-Hispanic white age-adjusted CVD mortality rates. County-level age-adjusted CVD mortality rates were adjusted for county-level demographic, socioeconomic, and healthcare factors. There were a total of 4 769 040 deaths among Hispanics (n=382 416) and non-Hispanic whites (n=4 386 624). Overall, cardiovascular age-adjusted mortality rates were higher among non-Hispanic whites compared with Hispanics (244.8 versus 189.0 per 100 000). Hispanic density ranged from 1% to 96% in each county. Counties in the highest compared with lowest category of Hispanic density had 60% higher Hispanic mortality (215.3 versus 134.2 per 100 000 population). In linear regression models, after adjusting for county-level demographic, socioeconomic, and healthcare factors, increasing Hispanic ethnic density remained strongly associated with mortality for Hispanics but not for non-Hispanic whites. Conclusions CVD mortality is higher in counties with higher Hispanic ethnic density. County-level characteristics do not fully explain the higher CVD mortality among Hispanics in ethnically concentrated counties

Racial and Ethnic Residential Segregation, the Neighborhood Socioeconomic Environment, and Obesity Among Blacks and Mexican Americans

We used cross-sectional data on 2,660 black and 2,611 Mexican-American adult participants in the National Health and Nutrition Examination Survey (1999–2006) to investigate the association between metropolitan-level racial/ethnic residential segregation and obesity and to determine whether it was mediated by the neighborhood socioeconomic environment. Residential segregation was measured using the black and Hispanic isolation indices. Neighborhood poverty and negative income incongruity were assessed as mediators. Multilevel Poisson regression with robust variance estimates was used to estimate prevalence ratios. There was no relationship between segregation and obesity among men. Among black women, in age-, nativity-, and metropolitan demographic-adjusted models, high segregation was associated with a 1.29 (95% confidence interval (CI): 1.00, 1.65) times higher obesity prevalence than was low segregation; medium segregation was associated with a 1.35 (95% CI: 1.07, 1.70) times higher obesity prevalence. Mexican-American women living in high versus low segregation areas had a significantly lower obesity prevalence (prevalence ratio, 0.54; 95% CI: 0.33, 0.90), but there was no difference between those living in medium versus low segregation areas. These associations were not mediated by neighborhood poverty or negative income incongruity. These findings suggest variability in the interrelationships between residential segregation and obesity for black and Mexican-American women

Racial and Ethnic Differences in the Association Between Obesity and Depression in Women

Background: It is generally accepted that obesity and depression are positively related in women. Very little prior research, however, has examined potential variation in this relationship across different racial/ethnic groups. This paper examines the association between obesity and depression in non-Hispanic White, non-Hispanic Black, and Mexican American women. Methods: The sample included women aged 20 years and older in the 2005?2008 National Health and Nutrition Examination Surveys (n=3666). Logistic regression was used to assess the relationship between obesity and depression syndrome (assessed using the Patient Health Questionnaire-9), after adjusting for covariates. We then investigated whether this association varied by race/ethnicity. Results: Overall, obese women showed a 73% greater odds of depression (odds ratio [OR]=1.73; 95% confidence interval [CI]=1.19, 2.53) compared with normal weight women. This association varied significantly, however, by race/ethnicity. The obesity-depression associations for both Black and Mexican American women were different from the positive association found for White women (ORBlack*obese=0.24; 95% CI=0.10,0.54; ORMexican American*obese=0.42; 95% CI=1.04). Among White women, obesity was associated with significantly greater likelihood of depression (OR=2.37; 95% CI=1.41, 4.00) compared to normal weight. Among Black women, although not statistically significant, results are suggestive that obesity was inversely associated with depression (OR=0.56; 95% CI=0.28, 1.12) relative to normal weight. Among Mexican American women, obesity was not associated with depression (OR=1.01; 95% CI=0.59, 1.72). Conclusions: The results reveal that the association between obesity and depression varies by racial/ethnic categorization. White, but not Black or Mexican American women showed a positive association. Next research steps could include examination of factors that vary by race/ethnicity that may link obesity to depression.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140124/1/jwh.2012.4111.pd

The Role of Physical Activity and Sedentary Behaviors in Explaining the Association between Acculturation and Obesity among Mexican-American Adults

We investigated associations of acculturation with various types of activity (moderate-vigorous leisure-time physical activity (LTPA), moderate-vigorous work- and transportation-related physical activity and sedentary activity), and whether these activities mediated the acculturation-obesity association among Mexican-Americans

Association of Childhood Psychosocial Environment With 30-Year Cardiovascular Disease Incidence and Mortality in Middle Age

Background Childhood adversity and trauma have been shown to be associated with poorer cardiovascular disease (CVD) outcomes in adulthood. However, longitudinal studies of this association are rare. Methods and Results Our study used the CARDIA (Coronary Artery Risk Development in Young Adults) Study, a longitudinal cohort that has followed participants from recruitment in 1985-1986 through 2018, to determine how childhood psychosocial environment relates to CVD incidence and all-cause mortality in middle age. Participants (n=3646) completed the Childhood Family Environment (CFE) questionnaire at the year 15 (2000-2001) CARDIA examination and were grouped by high, moderate, or low relative CFE adversity scores. We used sequential multivariable regression models to estimate hazard ratios of incident (CVD) and all-cause mortality. Participants were 25.1+/-3.6 years old, 47% black, and 56% female at baseline and 198 participants developed CVD (17.9 per 10 000 person-years) during follow-up. CVD incidence was \u3e 50% higher for those in the high CFE adversity group compared with those in the low CFE adversity group. In fully adjusted models, CVD hazard ratios (95% CI) for participants who reported high and moderate CFE adversity versus those reporting low CFE adversity were 1.40 (0.98-2.11) and 1.25 (0.89-1.75), respectively. The adjusted hazard ratios for all-cause mortality was 1.68 (1.17-2.41) for those with high CFE adversity scores and 1.55 (1.11-2.17) for those with moderate CFE adversity scores. Conclusions Adverse CFE was associated with CVD incidence and all-cause mortality later in life, even after controlling for CVD risk factors in young adulthood

Coming unmoored: Disproportionate increases in obesity prevalence among young, disadvantaged white women

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109980/1/oby20913.pd

Optimism and Cardiovascular Health: Multi-Ethnic Study of Atherosclerosis (MESA)

Objectives We examined the cross-sectional association between optimism and cardiovascular health (CVH). Methods We used data collected from adults aged 52–84 who participated in the Multi-Ethnic Study of Atherosclerosis (MESA) (n=5,134) during the first follow-up visit (2002–2004). Multinomial logistic regression was used to examine associations of optimism with ideal and intermediate CVH (with reference being poor CVH), after adjusting for socio-demographic factors and psychological ill-being. Results Participants in the highest quartile of optimism were more likely to have intermediate [OR=1.51:95%CI=1.25,1.82] and ideal [OR=1.92:95%CI=1.30,2.85] CVH when compared to the least optimistic group. Individual CVH metrics of diet, physical activity, BMI, smoking, blood sugar and total cholesterol contributed to the overall association. Conclusions We offer evidence for a cross-sectional association between optimism and CVH