Abstract Body: Introduction: Static neighborhood-level factors, such as access to healthcare and the physical environment, are associated with hypertension (HTN) risk. Less is known on how dynamic neighborhood changes (e.g. gentrification) impact HTN risk. We tested the hypothesis that individuals living in gentrified neighborhoods, compared to non-gentrified neighborhoods, have a decreased risk of HTN.
Methods: We quantified the association of living in a gentrified neighborhood with HTN status among 6260 participants from Visit 5 (2011-13) of the ARIC Study. A composite z-score was calculated from 2010 Census measures of median household income and gross rent, proportion of adults with a bachelor’s degree, and proportion living above the poverty level. The z-score was used in two frameworks to quantify gentrification: 1) a relative spatial comparison between a geocoded participant address-centric 0.5 mile radius and a surrounding 20-mile radius, and 2) temporal change in the spatial comparison between the 1990 and 2010 Census measures. The outcome was defined as no HTN (systolic blood pressure [SBP] <130 mmHg), controlled HTN (SBP <130 mmHg on medication), unmedicated HTN (SBP ≥130 mmHg), or medicated and uncontrolled HTN (SBP ≥130 mmHg on medication). Adjusted multinomial logistic regression quantified the odds of HTN. Models were further stratified by ARIC study site.
Results: Among the 6260 participants (mean age 76 years, 59% female, 22% Black), 843 (13%) had no HTN, 2387 (38%) had controlled HTN, 674 (11%) had unmedicated HTN, and 2356 (38%) had medicated and uncontrolled HTN. Compared to participants with no HTN, a one unit increase in the 2010 spatial gentrification z-score was associated with lower odds of controlled HTN and medicated and uncontrolled HTN, but not unmedicated HTN (Figure). There was a strong protective association of gentrification on HTN among White participants living in Forsyth County, NC and Washington County, MD. Among Black participants in Jackson, MS, living in a gentrified neighborhood was associated with increased odds of unmedicated HTN only. The pattern of associations was similar but attenuated for spatial and temporal gentrification z-score from 1990 to 2010.
Conclusions: Living in neighborhoods with higher spatial gentrification z-scores is associated with lower odds of HTN. Black and White participants in ARIC may have experienced gentrification differently, potentially alluding to long-term structural factors that impact health.