Assessing Biological Pathways: Linking Neighborhoods to Cardiovascular Mortality

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DESCRIPTION (provided by applicant): A growing number of studies report gender differences in how the neighborhood environment impacts individual health behaviors, health status, and/or mortality. Although research in this domain has made great strides, researchers are still in the early stages of identifying the biological pathways through which neighborhood characteristics actually "get under the skin," and the Institute of Medicine's (IOM) call for gender- based analyses has not been fulfilled. More specifically, research to date has lacked the necessary combination of data on individual-level sociodemographic, health behavior and biological markers, objective neighborhood data, and follow-up data on individual mortality. Also, there is a dearth of work systematically assessing gender differences in the association of neighborhood factors and cardiovascular disease (CVD) mortality in the United States. We propose to address this gap in the literature by assessing biological pathways between key aspects of the residential environment and CVD mortality in a national sample of adults. The specific aims of this proposed research are to: 1. Assess the relationship between selected characteristics of the neighborhood environment (i.e., neighborhood socioeconomic status (NSES), population density, and residential stability) and acquired biological risk factors for CVD and examine whether these relationships differ by gender, controlling for key individual-level health behavior and sociodemographic characteristics. 2. Assess the relationship between acquired biological risk factors for CVD and subsequent CVD mortality, and examine whether they differ by gender, controlling for key individual-level health behavior and sociodemographic characteristics. 3. Assess the role of acquired biological risk factors for CVD as mediating pathways between the selected characteristics of the neighborhood environment and CVD mortality, and examine how their role may differ by gender, controlling for key individual-level health behavior and sociodemographic characteristics. The proposed project will draw on integrated data from five major sources: (1) Third National Health and Nutrition Examination Survey (NHANES III), (2) the NHANES 1999-2004; (3) United States Census; (4) RAND Center for Population Health and Health Disparities (CPHHD) Data Core; and (5) National Death Index (NDI). Biomarkers are available through the NHANES data, including both traditional and more recently identified predictors of CVD risk and mortality. Taken together, these data provide a unique opportunity to assess key pathways between neighborhood context and men's and women's CVD risk and subsequent mortality. PUBLIC HEALTH RELEVANCE: The proposed research focuses on aspects of the social and physical environment of neighborhoods interventions in the area of building, housing, and land-use policy could address. This work will shed light on how related public policy efforts and public health interventions, particularly in the area of cardiovascular health, could-in the long term-improve health behaviors, cardiovascular risk factors, and survival, as well as reduce health disparities. The proposed gender-based analysis can also help inform efforts to improve population health for both men and women without inadvertently increasing health disparities.