Place-based Opportunities and Physiological Stress: Understanding Neighborhood-level Disparities in Allostatic Load

Background

Allostatic load, representing cumulative physiological stress, is linked to various health outcomes. While neighborhood conditions influence health, the relationship between comprehensive neighborhood opportunity measures and allostatic load remains understudied.

Methods

Using data from 2118 participants in the Midlife in the United States study, we examined associations between neighborhood opportunity (measured by the Childhood Opportunity Index) and allostatic load (measured using standard clinical cut-offs of eight biomarkers: systolic and diastolic blood pressure, hemoglobin A1C, high-density lipoprotein cholesterol, body mass index, waist circumference, total cholesterol, and c-reactive protein). The index comprised three subdomains: Education, Health and Environment, and Social and Economic Resources. Negative binomial regression models quantified these associations, adjusting for sociodemographic characteristics, health behaviors, and prescribed medication use.

Results

Lower Overall Neighborhood Opportunity was significantly associated with higher allostatic load, even after full covariate adjustment (18 % increase in expected allostatic load count, 95 % CI: 8 %–29 %, p < 0.001). Social and Economic Resources emerged as the subdomain that consistently tracked with expected allostatic load count. Negative binomial regression models provided evidence of similar significant patterns across the Education and Health and Environment models when comparing low to high groups.

Conclusions

Low neighborhood opportunity is associated with increased physiological stress as measured by allostatic load. These findings further indicate that neighborhood-level interventions may be crucial for reducing health inequities and improving population health outcomes.