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Cubbin C, Hadden WC, Winkleby MA. Neighborhood context and cardiovascular disease risk factors: the contribution of material deprivation

Stanford Center for Research in Disease Prevention, Stanford University School of Medicine, Palo Alto, California, USA.
Ethnicity & disease (Impact Factor: 0.92). 02/2001; 11(4):687-700.
Source: PubMed

ABSTRACT This paper investigates whether neighborhood material deprivation is associated with cardiovascular disease (CVD) risk factors (physical inactivity, diabetes, smoking, body mass index, blood pressure, cholesterol) independent of individual socioeconomic status (SES) in Black, Mexican-American, and White women and men aged 25-64 using data from the Third National Health and Nutrition Examination Survey (1988-1994, N = 9,961). The data were linked to 1990 Census tract characteristics (unemployment, car ownership, rented housing, crowded housing), which were used to construct a neighborhood-level material deprivation index. Results are stratified by gender and race/ethnicity. Multiple logistic and linear regression models were specified using SUDAAN to account for the clustered design. In general, residence in a deprived neighborhood increased the probability of having an adverse CVD risk profile, independent of an individual's SES. For example, after adjusting for SES, Black women living in deprived neighborhoods were at increased risk of being diabetic, being a smoker, and having a higher body mass index and blood pressure compared to Black women living in less deprived neighborhoods (P values <.05). Stronger associations were found between neighborhood deprivation and CVD risk factors in Blacks than in Mexican Americans despite living in similarly deprived neighborhoods. Neighborhood deprivation may influence CVD risk factors through a variety of mechanisms including the availability of healthy environments, municipal services, and political/cultural characteristics. Policies and interventions that address the socioeconomic context in which people live might reduce inequalities in CVD risk factors.

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    • "Residents of lower income areas have been shown to be more susceptible to conditions such as psychological distress and depression (Hill et al., 2005; Ross, 2000) obesity (Mujahid et al., 2008) and chronic disease (Cubbin et al., 2001; Murray et al., 2010). The mechanisms linking disadvantage to disease are varied and not always well understood; however, lower income groups that are also disproportionately composed of ethno racial minorities, including immigrants, are more likely to live in residentially segregated neighborhoods (Acevedo-Garcia and Lochner, 2003; Massey and Denton, 1998), areas of higher crime and with greater alcohol and fast food outlet density (Block et al., 2004; Cohen et al., 2008; Kwate et al., 2009), as well as areas with less access to municipal services like recreational facilities or walkable sidewalks that may promote health (Cubbin et al., 2001; Holmes and Marcelli, 2011; Lovasi et al., 2009a). "
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    • "There is also a need to examine the heterogeneous impact of the neighborhood alcohol environment according to gender or sex. While few studies have reported community or neighborhood differences across sexes, a growing body of evidence suggests that neighborhood social and built environments can and do affect men and women differently (Bird & Rieker, 1999; Cubbin, Hadden, & Winkleby, 2000; Do et al., 2007; Macintyre, Hunt, & Sweeting, 1996; Molinari, Ahern, & Hendryx, 1998). Males and females differ in their response to stress (Ross, 2000; Taylor, Repetti, & Seeman, 1997) and are also differently affected by social control processes (Ramirez-Valles, Zimmerman, & Juarez, 2002). "
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    • "Environmental conditions have been extensively explored as contributing factors in promoting health disparities (Lee, 2002; Sexton, 2000). It is widely accepted that racial/ethnic minority neighborhoods are disproportionately affected by increased rates of morbidity, mortality and adverse health outcomes (Cubbin et al., 2001; Deaton and Lubotsky, 2003). These disparities are believed to be associated with factors, including residential segregation, poverty and neighborhood deprivation (Gee and Payne-Sturges, 2004), which can lead to adverse health outcomes. "
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