An examination of the associations among neighborhood racial composition, neighborhood poverty, access to care, perceived discrimination and hypertension treatment: Does your zip code determine your health outcomes?

Background. Untreated hypertension is a fatal risk factor for coronary heart disease and is a strong predictor of uncontrolled hypertension. Untreated hypertension is more prevalent among men, racial/ethnic minorities, and impoverished populations. Residents of predominantly non-Hispanic Black and high-poverty neighborhoods maybe less likely to achieve hypertension control partly due to perceived discrimination and difficulty accessing healthcare, but the mechanisms through which these associations unfold have not been fully elucidated. In previous research, we found hypertensive non-Hispanic Blacks were more likely to be aware of their hypertension, but paradoxically, had lower treatment rates than non-Hispanic White and Hispanic Detroit residents. Data and Methods. We used two level hierarchical linear models to assess whether neighborhood racial composition and neighborhood poverty are correlates of hypertension treatment, and whether these associations are mediated by access to healthcare. Our data are from a multiethnic sample of Detroit residents (aged25+), conducted by the Healthy Environments Partnership, a CBPR partnership in Detroit. Results & Implications. Neighborhoods with higher concentrations of Blacks OR = 1.02, CI (95%, 1.00, 1.03), older adults OR = 1.06 CI (95%, 1.01, 1.10), and females OR = 5.37 CI (95%, 1.86, 15.46) were associated with higher odds of treatment. Surprisingly, individuals who reported occasions of perceived discrimination were more likely to receive treatment OR=3.36 CI (95%, CI 1.08, 10.49). Delays in seeking healthcare were negatively associated with receiving treatment OR= 0.17 (CI 95%, 0.03, 0.92). Results from these analyses inform priorities for intervention by identifying characteristics of neighborhoods associated with hypertension treatment efforts.