期刊
SOCIAL SCIENCE & MEDICINE
卷 65, 期 9, 页码 1853-1866出版社
PERGAMON-ELSEVIER SCIENCE LTD
DOI: 10.1016/j.socscimed.2007.05.038
关键词
neighborhoods; social disparities; multi-level modeling; health inequalities; hypertension; blood pressure
资金
- NICHD NIH HHS [R24 HD041028, R01 HD050467-01A1, R24 HD047861, R01 HD050467, R24 HD047861-01, R01HD050467, P50 HD038986, P50HD38986, P50 HD038986-010001] Funding Source: Medline
The spatial segregation of the US population by socioeconomic position and especially race/ethnicity suggests that the social contexts or neighborhoods in which people live may substantially contribute to social disparities in hypertension. The Chicago Community Adult Health Study did face-to-face interviews, including direct measurement of blood pressure, with a representative probability sample of adults in Chicago. These data were used to estimate socioeconomic and racial-ethnic disparities in the prevalence, awareness, treatment, and control of hypertension, and to analyze how these disparities are related to the areas in which people live. Hypertension was significantly negatively associated with neighborhood affluence/gentrification, and adjustments for context eliminated the highly significant disparity between blacks/African-Americans and whites, and reduced the significant educational disparity by 10-15% to borderline statistical significance. Awareness of hypertension was significantly higher in more disadvantaged neighborhoods and in places with higher concentrations of blacks (and lower concentrations of Hispanics and immigrants). Adjustment for context completely eliminated blacks' greater awareness, but slightly accentuated the lesser awareness of Hispanics and the greater levels of awareness among the less educated. There was no consistent evidence of either social disparities in or contextual associations with treatment of hypertension, given awareness. Among those on medication, blacks were only 40-50% as likely as whites to have their hypertension controlled, but context played little or no role in either the level of or disparities in control of hypertension. In sum, residential contexts potentially play a large role in accounting for racial/ethnic and, to a lesser degree, socioeconomic disparities in hypertension prevalence and, in a different way, awareness, but not in treatment or control of diagnosed hypertension. (C) 2007 Elsevier Ltd. All rights reserved.
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