Double-Jeopardy: The Joint Impact of Neighborhood Disadvantage and Low Social Cohesion on Cumulative Risk of Disease Among African American Men and Women in the Jackson Heart Study
Published Date:Feb 03 2016
Source:Soc Sci Med. 153:107-115.
Aged, 80 And Over
Cumulative Biological Risk
Health Status Disparities
Pubmed Central ID:PMC4788553
Funding:R01 HL071759/HL/NHLBI NIH HHS/United States
HHSN268201300049C/PHS HHS/United States
T32 HL 098048-02/HL/NHLBI NIH HHS/United States
HHSN268201300048C/PHS HHS/United States
P60 MD002249/MD/NIMHD NIH HHS/United States
HHSN268201300047C/PHS HHS/United States
U01 PS003315/PS/NCHHSTP CDC HHS/United States
5 R25 GM 055353/GM/NIGMS NIH HHS/United States
HHSN268201300048C/HL/NHLBI NIH HHS/United States
P60MD002249 05S1/MD/NIMHD NIH HHS/United States
HHSN268201300049C/HL/NHLBI NIH HHS/United States
HHSN268201300050C/PHS HHS/United States
HHSN268201300046C/PHS HHS/United States
HHSN268201300047C/HL/NHLBI NIH HHS/United States
HHSN268201300050C/HL/NHLBI NIH HHS/United States
T32 HL098048/HL/NHLBI NIH HHS/United States
HHSN268201300046C/HL/NHLBI NIH HHS/United States
R25 GM055353/GM/NIGMS NIH HHS/United States
Few studies have examined the joint impact of neighborhood disadvantage and low social cohesion on health. Moreover, no study has considered the joint impact of these factors on a cumulative disease risk profile among a large sample of African American adults. Using data from the Jackson Heart Study, we examined the extent to which social cohesion modifies the relationship between neighborhood disadvantage and cumulative biological risk (CBR)—a measure of accumulated risk across multiple physiological systems.
Our analysis included 4,408 African American women and men ages 21–85 residing in the Jackson, MS Metropolitan Area. We measured neighborhood disadvantage using a composite score of socioeconomic indicators from the 2000 US Census and social cohesion was assessed using a 5-item validated scale. Standardized z-scores of biomarkers representing cardiovascular, metabolic, inflammatory, and neuroendocrine systems were combined to create a CBR score. We used two-level linear regression models with random intercepts adjusting for socio-demographic and behavioral covariates in the analysis. A three-way interaction term was included to examine whether the relationship between neighborhood disadvantage and CBR differed by levels of social cohesion and gender.
The interaction between neighborhood disadvantage, social cohesion and gender was statistically significant (p=0.05) such that the association between living in a disadvantaged neighborhood and CBR was strongest for men living in neighborhoods with low levels of social cohesion (B=0.63, SE: 0.32). In gender-specific models, we found a statistically significant interaction between neighborhood disadvantage and social cohesion for men (p=0.05) but not for women (p=0.50).
Neighborhoods characterized by high levels of economic disadvantage and low levels of social cohesion contribute to higher cumulative risk of disease among African American men. This suggests that they may face a unique set of challenges that put them at greater risk in these settings.
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