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Original Research

Distribution of Cardiovascular Health by Individual- and Neighborhood-Level Socioeconomic Status: Findings From the Jackson Heart Study

Authors:

Randi E. Foraker ,

Institute for Informatics, Washington University in St. Louis School of Medicine, St. Louis, MO, US
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Christopher Bush,

Duke University School of Medicine, Durham, NC, US
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Melissa A. Greiner,

Duke University School of Medicine, Durham, NC, US
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Mario Sims,

University of Mississippi Medical Center, Jackson, MS, US
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Kamal Henderson,

University of North Carolina School of Medicine, Chapel Hill, NC, US
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Sakima Smith,

The Ohio State University Wexner Medical Center, Columbus, OH, US
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Aurelian Bidulescu,

Indiana University School of Public Health, Bloomington, IN, US
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Abigail B. Shoben,

The Ohio State University College of Public Health, Columbus, OH, US
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N. Chantelle Hardy,

Duke University School of Medicine, Durham, NC, US
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Emily O’Brien

Duke University School of Medicine, Durham, NC, US
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Abstract

Background: Data demonstrate a positive relationship between socioeconomic status (SES) and cardiovascular health (CVH).

Objective: To assess the association between individual- and neighborhood-level SES and CVH among participants of the JHS (Jackson Heart Study), a community-based cohort of African Americans in Jackson, Mississippi.

Methods: We included all JHS participants with complete SES and CVH information at the baseline study visit (n = 3,667). We characterized individual- and neighborhood-level SES according to income (primary analysis) and education (secondary analysis), respectively. The outcome of interest for these analyses was a CVH score, based on 7 modifiable behaviors and factors, summed to a total of 0 (worst) to 14 (best) points. We utilized generalized estimating equations to account for the clustering of participants within the same residential areas to estimate the linear association between SES and CVH.

Results: The median age of the participants was 55 years, and 64% were women. Nearly one-third of eligible participants had individual incomes <$20,000 and close to 40% lived in the lowest neighborhood income category (<$25,480). Adjusted for age, sex, and neighborhood SES, there was an average increase in CVH score of 0.31 points associated with each 1-category increase in individual income. Similarly, each 1-category increase in neighborhood SES was associated with a 0.19-point increase in CVH score. These patterns held for our secondary analyses, which used educational attainment in place of income. These data did not suggest a synergistic effect of individual- and neighborhood-level SES on CVH.

Conclusions: Our findings suggest a potential causal pathway for disparities in CVH among vulnerable populations. These data can be useful to the JHS community to empower public health and clinical interventions and policies for the improvement of CVH.

Highlights

  • An inverse relationship between SES and cardiovascular disease exists.
  • We found that higher levels of individual- and neighborhood-level SES are independently associated with better CVH.
  • Income and education are potential causal pathways for disparities in CVH among vulnerable populations.
  • Our findings have public health implications for clinicians who are treating individual patients as well as for policymakers who are seeking to provide an environment that supports CVH.
How to Cite: Foraker RE, Bush C, Greiner MA, Sims M, Henderson K, Smith S, et al.. Distribution of Cardiovascular Health by Individual- and Neighborhood-Level Socioeconomic Status: Findings From the Jackson Heart Study. Global Heart. 2019;14(3):241–50. DOI: http://doi.org/10.1016/j.gheart.2019.04.007
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Published on 01 Sep 2019.
Peer Reviewed

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