Abdel Magid Hoda S, Jaros Samuel, Lovasi Gina S, Rosso Andrea L, Tan Annabel X, Rehkopf David H, Nelson Lorene M, Carlson Michelle, Judd Suzanne E, Odden Michelle C
Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
Epidemiology and Community Health, Stanford University, Stanford, California, USA.
J Epidemiol Community Health. 2025 Aug 8;79(9):712-718. doi: 10.1136/jech-2024-223191.
Using data from the Cardiovascular Health Study (CHS) and the REasons for Geographic And Racial Differences in Stroke (REGARDS) study, we investigate the association between socioeconomic polarisation and blood pressure outcomes in black and white adults. We also validate previous findings that joint racial/ethnic and income measures of spatial social polarisation (SSP) outperform single domain measures.
We conducted a cross-sectional analysis using a retrospective cohort combining CHS (recruited 1989-1990 and 1992-1993) and REGARDS (recruited 2003-2007). The study included 5888 CHS participants aged ≥65 years and 30 183 REGARDS participants aged ≥45 years. SSP was measured using the Index of Concentration at the Extremes for education, race/ethnicity, income, home ownership, and joint race/ethnicity and income at ZIP code, census tract and county levels. The SSP measures were modelled against the presence of high blood pressure and systolic blood pressure.
The sample had a mean age of 66 (SD: 9), was majority female (56%), white/other (63%), and at least high school graduates (85%). A total of 26% had high blood pressure, with a mean systolic blood pressure of 129 mm Hg (SD: 18). Census tract-level models showed low-income black areas had 25% (95% CI 11%-40%) higher odds of high blood pressure and 1.8 mm Hg (95% CI 1.0-2.5) higher mean systolic blood pressure than high-income White areas.
Greater SSP is associated with a higher risk of high blood pressure and higher systolic blood pressure. Further investigating and reducing polarisation could help mitigate cardiovascular health disparities, improving outcomes for socioeconomically deprived communities.
利用心血管健康研究（CHS）和中风地理与种族差异原因（REGARDS）研究的数据，我们调查了黑人和白人成年人社会经济两极分化与血压结果之间的关联。我们还验证了先前的研究结果，即种族/族裔和收入的空间社会两极分化（SSP）联合测量指标比单一领域测量指标表现更好。
我们使用回顾性队列进行了横断面分析，该队列结合了CHS（1989 - 1990年和1992 - 1993年招募）和REGARDS（2003 - 2007年招募）。该研究包括5888名年龄≥65岁的CHS参与者和30183名年龄≥45岁的REGARDS参与者。SSP使用极端集中度指数在邮政编码、普查区和县层面测量教育程度、种族/族裔、收入、房屋所有权以及种族/族裔和收入联合情况。SSP测量指标针对高血压和收缩压的存在情况进行建模。
样本的平均年龄为66岁（标准差：9），多数为女性（56%），白人/其他种族（63%），至少是高中毕业生（85%）。共有26%的人患有高血压，平均收缩压为129毫米汞柱（标准差：18）。普查区层面的模型显示，低收入黑人地区患高血压的几率比高收入白人地区高25%（95%置信区间11% - 40%），平均收缩压高1.8毫米汞柱（95%置信区间1.0 - 2.5）。
更大的SSP与更高的高血压风险和更高的收缩压相关。进一步调查和减少两极分化有助于减轻心血管健康差异，改善社会经济贫困社区的健康结果。
