Effects of residential socioeconomic polarization on high blood pressure among nursing home residents

Hoda S Abdel Magid; Samuel Jaros; Yongmei Li; Michael A Steinman; Sei Lee; Carmen Peralta; Bocheng Jing; Kathy Fung; Christine K Liu; Xiaojuan Liu; Laura A Graham; Michelle C Odden

doi:10.1016/j.healthplace.2024.103243

Effects of residential socioeconomic polarization on high blood pressure among nursing home residents

Health Place. 2024 Apr 24:87:103243. doi: 10.1016/j.healthplace.2024.103243. Online ahead of print.

Authors

Affiliations

¹ Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, CA, USA; Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. Electronic address: hmagid@usc.edu.
² Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, CA, USA.
³ Division of Geriatrics, University of California San Francisco and the San Francisco VA Medical Center, SF, California, USA.
⁴ Division of Geriatrics, University of California San Francisco and the San Francisco VA Medical Center, SF, California, USA; Geriatrics, Palliative, and Extended Care Service Line, San Francisco VA Medical Center, San Francisco, CA, USA.
⁵ Section of Geriatric Medicine, Division of Primary Care and Population Health, School of Medicine, Stanford University, Stanford, CA, USA; Geriatric Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA.
⁶ Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, CA, USA; Geriatric Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA.
⁷ Health Economics Resource Center, VA Palo Alto Health Care System, Palo Alto, CA, USA; Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Department of Surgery, Stanford University, Stanford, CA, USA.

PMID: 38663339
DOI: 10.1016/j.healthplace.2024.103243

Abstract

Objective: Neighborhood concentration of racial, income, education, and housing deprivation is known to be associated with higher rates of hypertension. The objective of this study is to examine the association between tract-level spatial social polarization and hypertension in a cohort with relatively equal access to health care, a Veterans Affairs nursing home.

Methods: 41,973 long-term care residents aged ≥65 years were matched with tract-level Indices of Concentration at the Extremes across four socioeconomic domains. We modeled high blood pressure against these indices controlling for individual-level cardiovascular confounders.

Results: We found participants who had resided in the most disadvantaged quintile had a 1.10 (95% 1.01, 1.19) relative risk of high blood pressure compared to those in the other quintiles for the joint measuring race/ethnicity and income domain.

Conclusions: We achieved our objective by demonstrating that concentrated deprivation is associated with worse cardiovascular outcomes even in a population with equal access to care. Measures that jointly consider economic and racial/ethnic polarization elucidate larger disparities than single domain measures.

Keywords: Blood pressure; Cardiovascular disease; Hypertension; Nursing home; Polarization; Spatial analysis.

Grants and funding

F31 DA057107/DA/NIDA NIH HHS/United States