Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
J Gerontol B Psychol Sci Soc Sci. 2024 Jan 1;79(1). doi: 10.1093/geronb/gbad121.
Deprived living environments contribute to greater heart failure (HF) risk among non-Hispanic Black persons, who disproportionately occupy disadvantaged neighborhoods. The mechanisms for these effects are not fully explicated, partially attributable to an insufficient understanding of the individual factors that contribute additional risk or resilience to the impact of neighborhood disadvantage on health. The objective of this study was, therefore, to clarify the complex pathways over which such exposures act to facilitate more targeted, effective interventions. Given the evidence for a mediating role of biological age and a moderating role of individual psychosocial characteristics in the neighborhood disadvantage-HF link, we tested a moderated mediation mechanism.
Using multilevel causal moderated mediation models, we prospectively examined whether the association of neighborhood disadvantage with incident HF mediated through accelerated biological aging, captured by the GrimAge epigenetic clock, is moderated by hypothesized psychosocial risk (negative affect) and resilience (optimism) factors.
Among a sample of 1,448 Black participants in the shared Jackson Heart Study-Atherosclerosis Risk in Communities cohort (mean age 64.3 years), 334 adjudicated incident hospitalized HF events occurred over a median follow-up of 18 years. In models adjusted for age and sex, the indirect (GrimAge-mediated) effect of neighborhood disadvantage was moderated by psychosocial risk such that for every standard deviation increase in negative affect the hazards of HF was 1.18 (95% confidence interval = 1.05, 1.36). No moderated mediation effect was detected for optimism.
Findings support the necessity for multilevel interventions simultaneously addressing neighborhood and individual psychosocial risk in the reduction of HF among Black persons.
剥夺性的生活环境导致非西班牙裔黑人患心力衰竭（HF）的风险增加，而他们不成比例地居住在贫困社区。这些影响的机制尚未完全阐明，部分原因是对导致邻里劣势对健康影响的个体因素的额外风险或韧性的理解不足。因此，本研究的目的是阐明这些暴露作用的复杂途径，以促进更有针对性、更有效的干预措施。鉴于生物年龄的中介作用和个体心理社会特征在邻里劣势与 HF 关系中的调节作用的证据，我们测试了一个调节中介机制。
使用多层次因果调节中介模型，我们前瞻性地检查了邻里劣势与新发生 HF 的关联是否通过加速的生物衰老（由 GrimAge 表观遗传钟捕获）来介导，这种关联是否受到假设的心理社会风险（负性情绪）和韧性（乐观）因素的调节。
在共享 Jackson Heart 研究-社区动脉粥样硬化风险（Atherosclerosis Risk in Communities）队列的 1448 名黑人参与者中（平均年龄 64.3 岁），中位随访 18 年期间发生了 334 例经裁决的住院 HF 事件。在调整了年龄和性别的模型中，邻里劣势的间接（通过 GrimAge 介导的）效应受到心理社会风险的调节，即负性情绪每增加一个标准差，HF 的发病风险就会增加 1.18（95%置信区间为 1.05，1.36）。对于乐观主义，没有发现调节中介效应。
研究结果支持在降低黑人 HF 风险方面需要采取多层次干预措施，同时解决邻里和个体心理社会风险。
