Leveraging Spatial Epidemiology to Reduce Hypertension Disparities

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PROJECT SUMMARY Hypertension affects half of American adults but poses an especially severe burden on African Americans. Disparities in hypertension diagnosis, treatment, and control outcomes are spatially patterned. This spatial patterning is hypothesized to be due to area-level socioeconomic risk factors and area-level structural resources (e.g., healthy foods, recreation, healthcare, and housing). Leveraging detailed spatial data provides unique opportunities to drill down below common area-level studies and elucidate the mechanisms by which area-level factors produce hypertension disparities. Spatial social polarization (SSP) indices are potentially key to understanding hypertension disparities. SSP indices measure the extent to which populations are distributed at extremes of privilege and deprivation of socioeconomic domains. SSP indices can be meaningfully expanded to measure structural resources, representing key opportunities to examine hypertension disparities. Despite such promise, little research has evaluated the association between socioeconomic SSP and hypertension; and no prior research has quantified structural SSP or its relationship with hypertension disparities. The scientific objective of this proposal is to estimate the impact of eight SSP domains on hypertension disparities, evaluating both socioeconomic SSP (race/ethnicity, income, education, residential segregation) and structural SSP (food, recreation, healthcare, and housing) domains. The central hypothesis is that living in areas with high SSP increases hypertension disparities. This innovative project will leverage data from (1) the Cardiovascular Health Study (CHS); (2) the REasons for Geographic and Racial Differences in Strokes (REGARDS) study; (3) private and public claims data from Optum and Medicare; and (4) spatial data from the Retail Environment and Cardiovascular Disease (RECVD) study with geographic linkages to CHS and REGARDS cohorts. Research aims will (1) estimate the population-level effects of socioeconomic SSP predictors of hypertension prevalence, incidence, treatment, and control outcomes among Black and White adults; (2) develop a structural SSP index using measures of structural resources, and estimate the association between structural SSP and hypertension among Black and White adults; and (3) evaluate the extent to which socioeconomic and structural SSP mediate Black-White hypertension disparities. This research plan is complemented by a training plan that builds on the applicant’s background in epidemiology and biostatistics. The training plan includes measuring and modeling hypertension-specific SSP in diverse populations, analyzing large claims data, and applying causal inference methods. The combined research and training plans will prepare the applicant for a successful independent research career in epidemiology. The proposed research will improve public health surveillance of hypertension disparities, provide the evidence required to inform the development of SSP interventions, and invite further research on the causal pathways linking concentrations of privilege and deprivation to health disparities.