Neighborhoods with the greatest exposure to structural racism may carry higher burdens of cardiovascular risk factors and diseases, according to a recent study.
“The prevalence of cardiovascular disease differs substantially across neighborhoods,” wrote lead study author Wayne R. Lawrence, DrPH, of the Division of Cancer Epidemiology and Genetics at the National Cancer Institute of the National Institutes of Health, and colleagues. “However, few studies have examined the contribution of neighborhood-level structural racism to inequities in cardiovascular health.”
In the analysis, investigators found that census tracts in the highest structural-racism quintile experienced nearly double the prevalence of stroke compared with those in the lowest quintile. Diabetes prevalence was almost twice as high in the most disadvantaged neighborhoods. In geospatially matched tract pairs, stroke prevalence reached 4.8% in the highest-exposure neighborhoods compared with 2.2% in the lowest, diabetes reached 15.8% vs 7.6%, and obesity 39.5% vs 25.7%. Smoking prevalence was 24.1% in the highest-exposure areas compared with 11.9% in the lowest, and physical inactivity reached 35.7% vs 16.7%.
The investigators analyzed 71,915 US census tracts using the Structural Racism Effect Index which captures inequities across nine domains, including education, income and poverty, housing, employment, criminal justice, the built environment, social cohesion, transportation, and wealth. Cardiovascular clinical and behavioral risk factor estimates were derived from the CDC PLACES data set, based on the 2017 to 2018 Behavioral Risk Factor Surveillance System. Models were weighted for population size; clustered at the county level; and adjusted for demographic composition, insurance rates, routine checkup prevalence, and county-level supply of primary care and cardiovascular physicians.
Across all domains, structural racism remained strongly associated with higher prevalence of diabetes, obesity, hypertension, coronary heart disease, stroke, smoking, and physical inactivity. The steepest differentials appeared in the education and income-poverty domains, which showed the largest increases in stroke and diabetes prevalence between the lowest and highest exposure groups. These associations persisted after excluding racial composition from models and after matching census-tract pairs on the basis of region, metropolitan status, demographics, health care access, and geographic proximity.
The effects were observed across neighborhoods with varying racial and ethnic compositions. Obesity showed the strongest association in neighborhoods with the highest proportions of Black residents, diabetes in neighborhoods with high proportions of Hispanic or Latino residents, and coronary heart disease in neighborhoods with the highest proportion of White residents. High-exposure tracts were most often located in the South and had the highest percentage of uninsured adults, aligning with geographic patterns relevant to clinical practice.
This study was supported by the National Institutes of Health Intramural Research Program. One author reported personal fees from Exact Sciences; no other disclosures were reported.
Source: JAMA Health Forum
