Debora Kamin Mukaz, Andrew D Sparks, Timothy B Plante, Suzanne E Judd, George Howard, Virginia J Howard, Loni P Tabb, Lorraine T Dean, Mary Cushman
{"title":"居住种族隔离、社会经济地位和美国黑人和白人高血压风险:REGARDS前瞻性队列研究","authors":"Debora Kamin Mukaz, Andrew D Sparks, Timothy B Plante, Suzanne E Judd, George Howard, Virginia J Howard, Loni P Tabb, Lorraine T Dean, Mary Cushman","doi":"10.1161/JAHA.125.041339","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Black adults experience the highest hypertension burden of any racial group. It is unclear whether different dimensions of residential segregation have different relationships with hypertension risk for Black and White people, or whether socioeconomic status explains any of the relationships.</p><p><strong>Methods: </strong>We studied 6787 Black and White participants from the REGARDS (Reasons for Geographic And Racial Differences in Stroke) study, without prevalent hypertension and with follow-up for hypertension 9.4 years later. County-level segregation was defined using dissimilarity, isolation, and interaction indices. Associations between residential segregation indices and incident hypertension were estimated. Racial differences in associations and mediating effects of socioeconomic factors were assessed.</p><p><strong>Results: </strong>Risk ratios (RRs) of incident hypertension were 1.06 per SD higher isolation index (95% CI, 1.03-1.09) and 0.96 per SD higher interaction index (95% CI, 0.93-0.99). The dissimilarity index was not associated with hypertension risk. Neighborhood socioeconomic status explained 19% of the association between the isolation index and hypertension incidence. Although there were no statistically significant racial differences in associations, the isolation index was marginally associated with higher risk of hypertension in Black people only (RR, 1.05 [95% CI, 0.98-1.12]), and neighborhood socioeconomic status was a marginally significant mediator of that association (RR indirect effects, 0.993 [95% CI, 0.98-1.0004]).</p><p><strong>Conclusions: </strong>Findings indicated that living in racially segregated counties was associated with higher risk of hypertension, particularly for Black people. Higher neighborhood socioeconomic status may mitigate the negative effects of that aspect of residential segregation on hypertension development.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041339"},"PeriodicalIF":5.3000,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Residential Racial Segregation, Socioeconomic Status, and Hypertension Risk in Black and White Americans: The REGARDS Prospective Cohort Study.\",\"authors\":\"Debora Kamin Mukaz, Andrew D Sparks, Timothy B Plante, Suzanne E Judd, George Howard, Virginia J Howard, Loni P Tabb, Lorraine T Dean, Mary Cushman\",\"doi\":\"10.1161/JAHA.125.041339\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Black adults experience the highest hypertension burden of any racial group. It is unclear whether different dimensions of residential segregation have different relationships with hypertension risk for Black and White people, or whether socioeconomic status explains any of the relationships.</p><p><strong>Methods: </strong>We studied 6787 Black and White participants from the REGARDS (Reasons for Geographic And Racial Differences in Stroke) study, without prevalent hypertension and with follow-up for hypertension 9.4 years later. County-level segregation was defined using dissimilarity, isolation, and interaction indices. Associations between residential segregation indices and incident hypertension were estimated. Racial differences in associations and mediating effects of socioeconomic factors were assessed.</p><p><strong>Results: </strong>Risk ratios (RRs) of incident hypertension were 1.06 per SD higher isolation index (95% CI, 1.03-1.09) and 0.96 per SD higher interaction index (95% CI, 0.93-0.99). The dissimilarity index was not associated with hypertension risk. Neighborhood socioeconomic status explained 19% of the association between the isolation index and hypertension incidence. Although there were no statistically significant racial differences in associations, the isolation index was marginally associated with higher risk of hypertension in Black people only (RR, 1.05 [95% CI, 0.98-1.12]), and neighborhood socioeconomic status was a marginally significant mediator of that association (RR indirect effects, 0.993 [95% CI, 0.98-1.0004]).</p><p><strong>Conclusions: </strong>Findings indicated that living in racially segregated counties was associated with higher risk of hypertension, particularly for Black people. Higher neighborhood socioeconomic status may mitigate the negative effects of that aspect of residential segregation on hypertension development.</p>\",\"PeriodicalId\":54370,\"journal\":{\"name\":\"Journal of the American Heart Association\",\"volume\":\" \",\"pages\":\"e041339\"},\"PeriodicalIF\":5.3000,\"publicationDate\":\"2025-10-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the American Heart Association\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1161/JAHA.125.041339\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/9/30 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Heart Association","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/JAHA.125.041339","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/9/30 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Residential Racial Segregation, Socioeconomic Status, and Hypertension Risk in Black and White Americans: The REGARDS Prospective Cohort Study.
Background: Black adults experience the highest hypertension burden of any racial group. It is unclear whether different dimensions of residential segregation have different relationships with hypertension risk for Black and White people, or whether socioeconomic status explains any of the relationships.
Methods: We studied 6787 Black and White participants from the REGARDS (Reasons for Geographic And Racial Differences in Stroke) study, without prevalent hypertension and with follow-up for hypertension 9.4 years later. County-level segregation was defined using dissimilarity, isolation, and interaction indices. Associations between residential segregation indices and incident hypertension were estimated. Racial differences in associations and mediating effects of socioeconomic factors were assessed.
Results: Risk ratios (RRs) of incident hypertension were 1.06 per SD higher isolation index (95% CI, 1.03-1.09) and 0.96 per SD higher interaction index (95% CI, 0.93-0.99). The dissimilarity index was not associated with hypertension risk. Neighborhood socioeconomic status explained 19% of the association between the isolation index and hypertension incidence. Although there were no statistically significant racial differences in associations, the isolation index was marginally associated with higher risk of hypertension in Black people only (RR, 1.05 [95% CI, 0.98-1.12]), and neighborhood socioeconomic status was a marginally significant mediator of that association (RR indirect effects, 0.993 [95% CI, 0.98-1.0004]).
Conclusions: Findings indicated that living in racially segregated counties was associated with higher risk of hypertension, particularly for Black people. Higher neighborhood socioeconomic status may mitigate the negative effects of that aspect of residential segregation on hypertension development.
期刊介绍:
As an Open Access journal, JAHA - Journal of the American Heart Association is rapidly and freely available, accelerating the translation of strong science into effective practice.
JAHA is an authoritative, peer-reviewed Open Access journal focusing on cardiovascular and cerebrovascular disease. JAHA provides a global forum for basic and clinical research and timely reviews on cardiovascular disease and stroke. As an Open Access journal, its content is free on publication to read, download, and share, accelerating the translation of strong science into effective practice.