Associations between neighborhood socioeconomic cluster and hypertension, diabetes, myocardial infarction, and coronary artery disease within a cohort of cardiac catheterization patients

Neighborhood-level socioeconomic status (SES) is associated with health outcomes, including cardiovascular disease (CVD) and diabetes, but these associations are rarely studied across large, diverse populations. We used Ward’s Hierarchical clustering to define eight neighborhood clusters across North Carolina (NC) using 11 census-based indicators of SES, race, and urbanicity and assigned 6992 cardiac catheterization patients at Duke University Hospital to clusters. We examined associations between clusters and coronary artery disease (CAD), history of myocardial infarction (MI), hypertension, and diabetes using logistic regression adjusted for patient age, race, sex, body mass index, and smoking status. Four clusters were urban, three rural, and the referent cluster was suburban higher-middle-SES. We observed greater odds of MI in all clusters except the urban, high-SES, and higher-middle, majority White clusters. Odds of CAD were elevated in rural clusters that were low-SES and plurality Black (OR 1.39, 95% CI 1.15-1.69) and majority American Indian (OR 1.70, 95% CI 1.20-2.41). Odds of diabetes and hypertension were elevated in urban and rural low-SES, plurality Black clusters.. The social environment captured with this clustering methodology identified higher prevalence of CVD and diabetes in neighborhoods that were predominantly rural, low-SES, and non-White, demonstrating its use for future studies with diverse populations.

Impact/Purpose

A person’s socioeconomic status (SES) is associated with health, including cardiovascular diseases (CVD). The SES of a person’s neighborhood can also affect their health. We categorized census block groups in the state of North Carolina into eight distinct types of neighborhoods, or clusters, based on socioeconomic factors, racial distribution, and urbanicity/rurality. We then assigned 6992 cardiac catheterization patients at Duke University Hospital, many of whom have CVD, to their neighborhood cluster of residence. We assessed whether patients were more likely to have myocardial infarction (MI), coronary artery disease (CAD), hypertension, or diabetes based on the neighborhood cluster where they lived. Patients who lived in any low- or middle-SES neighborhood cluster were more likely to have MI compared to those who lived in the high-SES suburban cluster. Those who lived in low-SES rural clusters with large Black or American Indian populations were the most likely to have MI and CAD. Those who lived in urban and rural neighborhood clusters with large Black populations were more likely to have diabetes and hypertension. This study is important in that it was conducted in a large, diverse population and is one of the few studies to include substantial numbers of American Indian participants. This work may be informative to environmental justice teams and regions, in order to help identify communities at highest risk for CVD.

Citation

Weaver, A., L. McGuinn, L. Neas, R. Devlin, R. Dhingra, C. Ward-Caviness, W. Cascio, W. Kraus, E. Hauser, AND D. Diaz-Sanchez. Associations between neighborhood socioeconomic cluster and hypertension, diabetes, myocardial infarction, and coronary artery disease within a cohort of cardiac catheterization patients. Mosby Year Book Incorporated, Orlando, FL, 243:201-209, (2022). [DOI: 10.1016/j.ahj.2021.09.013]

DOI: Associations between neighborhood socioeconomic cluster and hypertension, diabetes, myocardial infarction, and coronary artery disease within a cohort of cardiac catheterization patients