标题：Association Between Neighborhood Disadvantage and Hypertension Prevalence, Awareness, Treatment, and Control in Older Adults: Results From the University of Alabama at Birmingham Study of Aging
摘要：Objectives. We evaluated the effect of neighborhood disadvantage (ND) on older adults’ prevalence, awareness, treatment, and control of hypertension. Methods. Data were from the University of Alabama at Birmingham Study of Aging, an observational study of 1000 community-dwelling Black and White Alabamians aged 65 years and older, in 1999 to 2001. We assessed hypertension prevalence, awareness, treatment, and control with blood pressure measurements and self-report data. We assessed ND with US Census data corresponding with participants’ census tracts, created tertiles of ND, and fit models with generalized estimating equations via a logit link function with a binomial distribution. Adjusted models included variables assessing personal advantage and disadvantage, place-based factors, sociodemographics, comorbidities, and health behaviors. Results. Living in mid-ND (adjusted odds ratio [AOR] = 1.6; 95% confidence interval [CI] = 1.2, 2.1) and high-ND tertiles (AOR = 1.8; 95% CI = 1.3, 2.3) was associated with higher hypertension prevalence, and living in high-ND tertiles was associated with lower odds of controlled hypertension (AOR = 0.6; 95% CI = 0.4, 0.6). In adjusted models, ND was not associated with hypertension awareness or treatment. Conclusions. These findings show that neighborhood environmental factors matter for hypertension outcomes and suggest the importance of ND for hypertension management in older adults. The characteristics of the geographic spaces or neighborhoods where people live influence their health throughout the life course. 1–9 The mechanisms whereby neighborhood characteristics affect individuals’ health include psychosocial and material resources in those geographic spaces. Specifically, neighborhoods have the potential to be a source of social capital, providing support to persons in need; to have physical capital, offering parks and recreation resources for physical activity; and to have human capital, generating economic output. Any of these resources can contribute to the overall well-being of individuals living there. 10 Alternatively, stress caused by high crime, low social support, limited economic resources, or a lack of material resources such as health services 6 may ultimately negatively affect the health of individuals living in a neighborhood. Furthermore, limited community-based assistance programs, as well as limited access to healthful foods or adequate shopping opportunities and recreational facilities 11 in disadvantaged neighborhoods may also have adverse effects on health. The daily stress of living in such disadvantaged neighborhoods may place a high burden on individuals’ physiological systems, a burden which is sometimes called allostatic load. 12,13 These risks and benefits of neighborhood contexts may accrue over a long period of time and may affect people either right away or for many years in the future 14 and lead to conditions such as hypertension. In fact, neighborhood-level psychosocial and material deprivations are particularly problematic for individuals’ cardiovascular health and for management of cardiovascular risk factors. In 2004, Diez Roux et al. 15 demonstrated an association between negative environments and both cardiovascular and noncardiovascular mortality. Other researchers have found similar effects, including Mujahid et al. 16 who showed that walkability, access to healthy food, greater safety, and greater social cohesion were associated with a lower likelihood of hypertension. Although these findings are useful for gaining insights into the general population, work is needed to assess the effects of neighborhood characteristics on specific, unique subpopulations. To that end, there has been a growing interest in the effects of neighborhood context on older adults because of their potentially greater sensitivity (than the general population) to the effects of their neighborhood contexts on health. 8,17–22 This is particularly important, as Lawton and Simon purported in the environmental docility hypothesis, 23 because, as persons age and become more ill, losing control of their ability to perform activities of daily living, they may become more sensitive to characteristics of their environments, including the neighborhoods where they live. Specifically, then, older adults’ inability to navigate through disadvantaged neighborhoods may put them at higher risk for hypertension because of more concentrated exposure to psychosocial stressors. In addition, deprivation of health services including access to physicians and pharmacies in disadvantaged neighborhoods may cause adverse outcomes. Finally, older adults’ negative perception of their neighborhood environment may have a negative impact on their likelihood of being mobile and active, even when, in reality, theirs is not an unsafe or disadvantaged neighborhood. Although there is a burgeoning literature on the relationship between neighborhood characteristics and cardiovascular outcomes and a growing interest in neighborhood effects on older adults, no work known to these authors has examined neighborhood effects on hypertension specifically among older adults. Therefore, we aimed to assess if an association exists between neighborhood disadvantage (ND), measured by a validated ND index (NDI), 24 and hypertension prevalence, awareness, treatment, and control in a cohort of community-dwelling older adults.
