1 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA.
2 Division of Epidemiology School of Public Health University of California, Berkeley Berkeley CA.
J Am Heart Assoc. 2019 Jun 18;8(12):e011633. doi: 10.1161/JAHA.118.011633. Epub 2019 Jun 15.
Background Factors promoting cardiovascular health in the face of high risk, ie, resilience, are unknown and may identify novel areas of intervention for reducing racial health disparities. We examined neighborhood perceptions and psychological attributes of blacks living in high and low cardiovascular-risk neighborhoods, as potential characteristics of resilience promoting cardiovascular health. Methods and Results We identified 1433 blacks residing in census tracts of Atlanta, GA , with higher-than-expected ("high" risk) or lower-than-expected ("low" risk) rates of cardiovascular mortality, hospitalizations, and emergency department visits during 2010-2014. Domains of psychosocial well-being and neighborhood quality were assessed via telephone survey between August 2016 and October 2016. Using multilevel logistic regression, odds of reporting better resilient characteristics were compared between individuals living in low- versus high-risk neighborhoods. Those from low-risk (versus high-risk) neighborhoods reported better neighborhood aesthetic quality (odds ratio [ OR ], 1.84), healthy food access ( OR , 1.69), and absence of violence ( OR , 0.67). Individuals from low-risk neighborhoods reported greater optimism ( OR , 1.38), purpose in life ( OR , 1.42), and fewer depressive symptoms ( OR , 0.69). After full adjustment, these associations remained significant for neighborhood factors (aesthetic quality, healthy food access, violence) and psychosocial well-being (purpose in life). We found no evidence of differences in self-reported cardiovascular risk factors or disease history between low- versus high-risk neighborhoods. Conclusions Positive neighborhood environments and psychological characteristics are associated with low cardiovascular-risk neighborhoods, despite similar prevalence of cardiovascular risk factors, in the census tracts studied. These factors may confer cardiovascular resilience among blacks.
在面临高风险时促进心血管健康的背景因素,即韧性,尚不清楚,可能为减少种族健康差异提供新的干预领域。我们研究了生活在心血管风险高低社区的黑人对社区的看法和心理特征,这些因素可能是促进心血管健康的韧性的潜在特征。
我们确定了居住在佐治亚州亚特兰大市的 1433 名黑人,他们在 2010-2014 年期间的心血管死亡率、住院率和急诊就诊率高于(“高”风险)或低于(“低”风险)预期的人口普查区。通过电话调查在 2016 年 8 月至 10 月期间评估了心理社会幸福感和社区质量的各个领域。使用多层逻辑回归,比较了生活在低风险与高风险社区的个体报告具有更好的弹性特征的可能性。与高风险社区(相比,低风险社区的人报告了更好的邻里美学质量(优势比[OR],1.84)、更方便获得健康食品(OR,1.69)和更少的暴力(OR,0.67)。来自低风险社区的个体报告了更高的乐观主义(OR,1.38)、生活目标(OR,1.42)和更少的抑郁症状(OR,0.69)。经过充分调整,这些与邻里因素(美学质量、健康食品获取、暴力)和心理社会幸福感(生活目标)相关的关联仍然具有统计学意义。我们没有发现低风险与高风险社区之间自我报告的心血管危险因素或疾病史存在差异。
尽管在研究的人口普查区中,心血管风险因素的流行率相似,但积极的邻里环境和心理特征与低心血管风险社区相关,这可能为黑人提供心血管弹性。