Journal
HYPERTENSION
Volume 79, Issue 1, Pages 196-206Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/HYPERTENSIONAHA.120.15196
Keywords
cardiovascular diseases; hypertension; mortality; public health; stroke
Categories
Funding
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health, Department of Health and Human Service [U01 NS041588]
- National Institute on Aging (NIA), National Institutes of Health, Department of Health and Human Service [U01 NS041588]
- National Heart, Lung, and Blood Institute [R01 HL080477, K01HL133468]
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The increase in social vulnerabilities is associated with a higher risk of developing hypertension and dying. The association between social vulnerability count and risk varies by race. The more social vulnerabilities an individual has, the higher the risk of developing hypertension and dying.
Social vulnerabilities increase the risk of developing hypertension and lower life expectancy, but the effect of an individual's overall vulnerability burden is unknown. Our objective was to determine the association of social vulnerability count and the risk of developing hypertension or dying over 10 years and whether these associations vary by race. We used the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) and included participants without baseline hypertension. The primary exposure was the count of social vulnerabilities defined across economic, education, health and health care, neighborhood and built environment, and social and community context domains. Among 5425 participants of mean age 64 +/- 10 SD years of which 24% were Black participants, 1468 (31%) had 1 vulnerability and 717 (15%) had >= 2 vulnerabilities. Compared with participants without vulnerabilities, the adjusted relative risk ratio for developing hypertension was 1.16 (95% CI, 0.99-1.36) and 1.49 (95% CI, 1.20-1.85) for individuals with 1 and >= 2 vulnerabilities, respectively. The adjusted relative risk ratio for death was 1.55 (95% CI, 1.24-1.93) and 2.30 (95% CI, 1.75-3.04) for individuals with 1 and >= 2 vulnerabilities, respectively. A greater proportion of Black participants developed hypertension and died than did White participants (hypertension, 38% versus 31%; death, 25% versus 20%). The vulnerability count association was strongest in White participants (P value for vulnerability countxrace interaction: hypertension=0.046, death=0.015). Overall, a greater number of socially determined vulnerabilities was associated with progressively higher risk of developing hypertension, and an even higher risk of dying over 10 years.
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