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APHA Scientific Session and Event Listing

Toms Augustin, MD, MPH¹, Thomas. A. Glass, PhD², Aparna Roy, MD MPH³, Bryan D. James, MBioethics², and Brian Schwartz, MD, MS². (1) Centre on Aging and Health, Johns Hopkins University, 2024 E Monument St., Suite 2-720, Baltimore, MD 21205, (410) 614-3758, taugust2@jhmi.edu, (2) Department of Epidemiology, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, (3) Department of Pediatrics, Johns Hopkins University, 600 N Wolfe St, Brady 320, Baltimore, MD 21287

Previous studies have found associations between neighborhood socioeconomic status (SES) and cardiovascular disease, but the mechanisms underlying this association have not been characterized . Few studies have examined specific aspects of neighborhood social context to address this question. We hypothesized that neighborhood psychosocial hazards would be associated with self-reported history of several atherosclerotic diseases (myocardial infarction [MI], stroke, transient ischemic attack [TIA] and intermittent claudication [IC]). To test this hypothesis, we used first-visit data from the Baltimore Memory Study, a population-based cohort of men and women ages 50-70 years randomly chosen from 65 urban neighborhoods. We constructed the Multidimensional Neighborhood Hazards Scale (MNHS) based on a factor analysis of 13 indicators of census and non-census data for each of the neighborhoods. Hierarchical (multilevel) regression was used to adjust for the clustering of persons within neighborhoods. After adjustment for individual SES and established risk factors for atherosclerosis, residence in neighborhoods in the highest quartile of the MNHS had an odds ratio (95% CI) of 4.68 (1.50, 14.6) for MI, 3.57 (1.30, 9.75) for MI or stroke or TIA, and 3.81 (1.58, 9.23) for MI, or stroke or TIA or IC. Additionally, there was a step-wise increase in the odds for all four conditions across quartiles of the MNHS (p for trend < 0.05). Living in a neighborhood with more psychosocial hazards was associated with increased odds of 4 diseases with predominant atherosclerotic origin. This suggests that the association between neighborhood characteristics and atherosclerosis may be mediated in part by environmental stress.

Learning Objectives:

• List 3 key studies showing associations of neighborhood and health especially cardiovascular health
• Recognize new evidence for the possible role of chronic environmental stress in cardiovascular disease and atherogenesis in older adults.
• Identify the characteristcs, strengths and limitation of the Baltimore Memory Study.

Keywords: Chronic Diseases, Environmental Exposures

Presenting author's disclosure statement:

Any relevant financial relationships? No