Department of Epidemiology and Biostatistics, University of California, San Francisco.
Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts.
JAMA Netw Open. 2023 Sep 5;6(9):e2335534. doi: 10.1001/jamanetworkopen.2023.35534.
The local environment remains an understudied contributor to elevated blood pressure among older adults. Untargeted approaches can identify neighborhood conditions interrelated with racial segregation that drive hypertension disparities.
To evaluate independent associations of sociodemographic, economic, and housing neighborhood factors with elevated blood pressure.
DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, the sample included Health and Retirement Study participants who had between 1 and 3 sets of biennial sphygmomanometer readings from 2006 to 2014 or 2008 to 2016. Statistical analyses were conducted from February 5 to November 30, 2021.
Fifty-one standardized American Community Survey census tract variables (2005-2009).
Elevated sphygmomanometer readings over the study period (6-year period prevalence): a value of at least 140 mm Hg for systolic blood pressure and/or at least 90 mm Hg for diastolic blood pressure. Participants were divided 50:50 into training and test data sets. Generalized estimating equations were used to summarize multivariable associations between each neighborhood variable and the period prevalence of elevated blood pressure, adjusting for individual-level covariates. Any neighborhood factor associated (Simes-adjusted for multiple comparisons P ≤ .05) with elevated blood pressure in the training data set was rerun in the test data set to gauge model performance. Lastly, in the full cohort, race- and ethnicity-stratified associations were evaluated for each identified neighborhood factor on the likelihood of elevated blood pressure.
Of 12 946 participants, 4565 (35%) had elevated sphygmomanometer readings (median [IQR] age, 68 [63-73] years; 2283 [50%] male; 228 [5%] Hispanic or Latino, 502 [11%] non-Hispanic Black, and 3761 [82%] non-Hispanic White). Between 2006 and 2016, a lower likelihood of elevated blood pressure was observed (relative risk for highest vs lowest tertile, 0.91; 95% CI, 0.86-0.96) among participants residing in a neighborhood with recent (post-1999) in-migration of homeowners. This association was precise among participants with non-Hispanic White and other race and ethnicity (relative risk, 0.91; 95% CI, 0.85-0.97) but not non-Hispanic Black participants (relative risk, 0.97; 95% CI, 0.85-1.11; P = .48 for interaction) or Hispanic or Latino participants (relative risk, 0.84; 95% CI, 0.65-1.09; P = .78 for interaction).
In this cohort study of older adults, recent relocation of homeowners to a neighborhood was robustly associated with reduced likelihood of elevated blood pressure among White participants but not their racially and ethnically marginalized counterparts. Our findings indicate that gentrification may influence later-life blood pressure control.
老年人血压升高的局部环境仍然是一个研究不足的因素。非靶向方法可以识别与种族隔离相关的邻里条件，这些条件会导致高血压的差异。
评估社会人口统计学、经济和住房邻里因素与血压升高的独立关联。
设计、地点和参与者：在这项队列研究中，样本包括健康与退休研究参与者，他们在 2006 年至 2014 年或 2008 年至 2016 年期间有 1 到 3 套两年一次的血压计读数。统计分析于 2021 年 2 月 5 日至 11 月 30 日进行。
51 个标准化的美国社区调查普查区变量（2005-2009 年）。
研究期间（6 年期间的患病率）血压升高的读数：收缩压至少 140 毫米汞柱和/或舒张压至少 90 毫米汞柱。参与者被平均分为 50:50 的训练和测试数据集。使用广义估计方程总结每个邻里变量与血压升高的多变量关联，同时调整个体水平的协变量。在训练数据集中，任何与血压升高相关的（经 Simes 调整的多重比较 P 值≤.05）的邻里因素都会在测试数据集中重新运行，以评估模型性能。最后，在全队列中，评估了每个识别出的邻里因素在种族和民族分层下对血压升高的可能性的关联。
在 12946 名参与者中，有 4565 名（35%）血压计读数升高（中位数[IQR]年龄，68[63-73]岁；2283 名[50%]男性；228 名[5%]西班牙裔或拉丁裔，502 名[11%]非西班牙裔黑人，3761 名[82%]非西班牙裔白人）。在 2006 年至 2016 年期间，与居住在最近（1999 年后）有房主迁入的邻里的参与者相比，血压升高的可能性较低（最高与最低三分位的相对风险，0.91；95%置信区间，0.86-0.96）。这种关联在非西班牙裔白人和其他种族和族裔的参与者中是准确的（相对风险，0.91；95%置信区间，0.85-0.97），但在非西班牙裔黑人参与者中则不然（相对风险，0.97；95%置信区间，0.85-1.11；P=0.48 用于交互作用）或西班牙裔或拉丁裔参与者（相对风险，0.84；95%置信区间，0.65-1.09；P=0.78 用于交互作用）。
在这项对老年人的队列研究中，最近房主搬迁到一个邻里与白人参与者血压升高的可能性降低显著相关，但与他们在种族和民族上处于边缘地位的对应者无关。我们的发现表明，中产阶级化可能会影响老年人的血压控制。
