摘要：Objectives. We examined the relation between median housing value and hypertension risk among US Black women. Methods. We gathered data from the Black Women’s Health Study, a prospective follow-up of 59000 Black women aged 21 to 69 years in 1995. Median housing value from US census data was used to measure neighborhood socioeconomic status. Cases of hypertension were identified through postal questionnaires mailed in 1997, 1999, and 2001. Clustered survival regression models were used to estimate incidence rate ratios. Results. During 180294 person-years of observation, 3780 cases of hypertension were reported. A significant inverse, graded association was found between median housing value and hypertension. The incidence rate ratio for women living in low median housing value neighborhoods relative to high was 1.29 (95% confidence interval=1.14, 1.45) after adjustment for individual risk factors. The association was evident even at higher individual levels of income and education. Conclusions. Median housing value is inversely associated with hypertension in Black women, independent of individual risk factors. Lowering hypertension risk in Black women will require a greater understanding of the underlying social inequalities that adversely affect health. Hypertension, one of the most important modifiable risk factors for cardiovascular disease, affects an estimated 24% of the adult population of the United States. 1 – 3 The incidence among Black women is 2 to 3 times that among White women, and Black women have appreciably higher rates of hypertension-related illness such as cardiovascular disease and end-stage renal disease. 4 The neighborhoods in which people live may affect individual health by shaping the social, service, and physical environments. 5 – 8 Neighborhood safety and the availability of recreational spaces may promote social cohesion 6 , 7 and encourage physical activity. 9 , 10 The quality and quantity of municipal services such as police, fire, and sanitation influence the risk of bodily harm and exposure to pests and infectious agents, 7 , 11 and the availability of full-service grocery stores (large supermarkets that offer quality produce, fresh meat, and dairy items, in addition to on-site pharmacies, fish markets, delicatessens, bank branches and automated teller machines) offering affordable and healthy foods may influence individual dietary choices and nutritional intake. 12 – 14 The age and condition of housing and the proximity to industrial facilities may increase exposure to toxic contaminants such as lead paint and pollution. 5 , 7 Furthermore, neighborhoods influence individual access to education, quality housing, and employment opportunities. 15 , 16 Several studies have found that persons living in poorer residential neighborhoods have an increased prevalence of risk factors for coronary heart disease (CHD) and an increased risk for all-cause and CHD mortality. 17 – 24 Three studies assessed hypertension in Black women. 25 – 27 In a study in Detroit, Mich, blood pressure levels among Black women residing in “high-stress” neighborhoods were higher than blood pressure levels among those residing in “low-stress” areas. 25 In the Atherosclerosis Risk in Communities study, neighborhoods marked by low income and low education levels were associated with higher rates of hypertension and other risk factors for CHD among Black women. 26 In the Third National Health and Nutrition Examination Survey (NHANES III; 1988–1994), living in deprived neighborhoods was found to increase the probability of having a poor cardiovascular disease risk profile, including hypertension, regardless of race and individual socioeconomic status (SES). 27 The Detroit study drew on equal numbers of predominately Black census tracts that were defined as either low income or upper-middle income, but only 246 Black women were included in the analysis. 25 Most of the Black participants in the Atherosclerosis Risk in Communities study were drawn from Jackson, Miss, a poor, southern, racially homogeneous, urban community. 26 In the NHANES III sample, more than 75% of the Black men and women lived in communities with higher rates of deprivation than those living in the average US neighborhood. 27 Thus, virtually no data are available on the relation between neighborhood and hypertension in middle-class Black women. Evidence indicates that higher education and income do not translate into the same level of financial and housing opportunity for Blacks as for Whites 5 , 6 , 16 , 28 – 30 ; that is, middle-class Black persons are more likely to live in poorer-quality neighborhoods than are their White counterparts and, as a result, remain exposed to the deleterious conditions associated with those neighborhoods. Furthermore, Black women report poorer health, including higher rates of hypertension, than do White women at all levels of income. 25 – 27 , 31 Therefore, to better understand racial disparities in hypertension and other illnesses, it is important to study the effects of socioeconomic characteristics of the neighborhoods in which these women live. This study extended the existing literature on neighborhood of residence and individual risk of hypertension. We used data from the Black Women’s Health Study (BWHS), a large national study of Black women, to examine prospectively the influence of neighborhood socioeconomic context, measured as median housing value, on the risk for hypertension in a cohort of Black women that included numerous women of middle and higher SES.
