Pilot Study for Geospatial Analysis of Neighborhood Environmental Stress in Relation to Biological Markers of Cardiovascular Health and Health Behaviors in Women

我们使用1999-2002年国家健康和营养检查调查的流行病学数据来评估邻里剥夺指数（NDI）和对数转换白细胞端粒长度（LTL）之间的关系，以开始评估剥夺邻里条件可能导致心血管（CV）健康不良的生物学机制。我们使用多层次建模来控制人口普查区级聚类。我们使用NDI的三分位数（ref =低NDI）构建模型。NDI是使用2000年美国人口普查的人口普查区社会经济指标计算的。样本（n = 5，106名成人）为49.8%的女性，包括82.9%的非西班牙裔白人，9.4%的非西班牙裔黑人和7.6%的墨西哥裔美国人。平均年龄为45.8岁。高NDI社区的居民更年轻，非白人，社会经济水平较低（所有p < 0.0001）。与低NDI相比，居住在中等NDI和高NDI社区的个人中，邻里剥夺与LTL呈负相关。在男性中，与低NDI相比，中等和高NDI与较短的LTL相关。在女性中，与低NDI相比，只有中等NDI与较短的LTL相关。在控制个人特征，包括个人层面的社会经济地位，增加邻里社会经济剥夺与较短的LTL在美国的成年人的全国代表性样本。我们的研究结果表明，端粒缩短可能是一种机制，通过这种机制，邻里剥夺导致CV健康状况不佳。 为了表征可能受到邻近环境的慢性应激源影响的免疫细胞，我们在一个染色方案中组合了多种流式细胞术抗体，以表征粒细胞、淋巴细胞和单核细胞亚群及其具有低血容量（500微升全血）的血小板聚集体。与全血细胞计数和分类计数相比，该流式细胞术组能够进行更广泛的比较。在用血库献血者的血液样本建立低容量流面板时，我们发现，当比较非洲裔美国人和高加索人献血者时，免疫细胞群不同。我们发现先前报道的不同种族/民族之间粒细胞和淋巴细胞计数的差异，支持我们小组的有效性。我们还发现了以前没有报道过的差异，如单核细胞亚群分布，自然杀伤（NK）细胞亚群，NKT细胞和血小板-单核细胞亚群聚集体的差异。 确定单核细胞和NK亚型的种族/民族差异是重要的初步数据，因为1）单核细胞对动脉粥样硬化形成至关重要; 2）NK细胞，特别是，可以通过社会压力改变，和3）单核细胞-血小板聚集体已被强调为对女性心肌梗死风险具有重要意义。这些发现使我们关注单核细胞和NK细胞群体作为感兴趣的免疫细胞，以及它们在将不利环境条件下的慢性应激与CV风险联系起来方面的潜在参与。 在COVID-19大流行和明显的健康差异已经暴露的背景下，我们强调了将流行病学方法与转化科学相结合的跨学科研究的迫切需要，包括免疫系统功能的表型分析。 虽然这类工作存在许多挑战，但这些研究可以确定受不良心理和环境条件影响最大的关键生物途径，并作为干预目标。 研究逆境的生物学影响的研究有望为处于风险中，服务不足的人群创造量身定制的干预措施。 最后，为了更好地了解邻里因素在心理社会压力源中的作用，我们使用2011-2014年全国健康和营养检查调查的数据研究了邻里社会经济劣势与抑郁症之间的关系。 我们发现，那些生活在社会经济地位较低的社区的人与更严重的抑郁症和更大的临床相关抑郁症的可能性有关。 然而，这种关联因个人层面的社会经济地位而减弱。

We used epidemiologic data from the 1999-2002 National Health and Nutrition Examination Surveys to assess the relationship between neighborhood deprivation index (NDI) and log-transformed leukocyte telomere length (LTL) to begin to assess the biological mechanisms by which deprived neighborhood conditions may lead to poor cardiovascular (CV) health. We used multilevel modeling to control for census tract level clustering. We constructed models using tertiles of NDI (ref = low NDI). NDI was calculated using census tract level socioeconomic indicators from the 2000 U.S. Census. The sample (n = 5,106 adults) was 49.8% female and consisted of 82.9% non-Hispanic whites, 9.4% non-Hispanic blacks, and 7.6% Mexican Americans. Mean age was 45.8 years. Residents of neighborhoods with high NDI were younger, non-white, and had lower socioeconomic levels (all p < 0.0001). Neighborhood deprivation was inversely associated with LTL among individuals living in neighborhoods with medium NDI and high NDI as compared to low NDI. Among men, both medium and high NDI were associated with shorter LTL as compared to low NDI. Among women, only medium NDI was associated with shorter LTL as compared to low NDI. After controlling for individual characteristics, including individual-level socioeconomic status, increasing neighborhood socioeconomic deprivation is associated with shorter LTL among a nationally representative sample of adults in the United States. Our findings suggest that telomere shortening may be a mechanism through which neighborhood deprivation results in poor CV health outcomes. To characterize immune cells that may be impacted by the chronic stressors of neighborhood environment, we combined a variety of flow cytometry antibodies in one staining protocol to characterize granulocyte, lymphocyte, and monocyte sub-populations and their platelet aggregates with low blood volumes (500 microliters of whole blood). This flow cytometry panel enabled a more extensive comparison than what is possible with a complete blood count and differential. While establishing the low-volume flow panel with blood samples from blood bank donors, we found that the immune cell populations differed when comparing African-American and Caucasian blood donors. We found previously reported differences in granulocyte and lymphocyte counts between the racial/ethnic groups, supporting the validity of our panel. We also detected differences that had not been previously reported, like differences in the monocyte subset distribution, natural killer (NK) cell subsets, NKT cells, and platelet-monocyte subset aggregates. Identifying racial/ethnic differences in monocyte and NK subtypes are important preliminary data as 1) monocytes are crucial to atherogenesis; 2) NK cells, in particular, can be altered by social stress, and 3) monocyte-platelet aggregates have been highlighted to be of significance for myocardial infarction risk among women. These findings have led us to focus on monocyte and NK cell populations as immune cells of interest and their potential involvement in linking chronic stress from adverse environmental conditions to CV risk. In the setting of the COVID-19 pandemic and the clear health disparities that have been laid bare, we highlighted the critical need for interdisciplinary studies that combine both epidemiologic methods with translational science, including phenotyping of immune system function. While numerous challenges exist in this type of work, these studies could identify key biologic pathways that are most impacted by adverse psychosocial and environmental conditions and serve as targets for intervention. Studies that examine the biologic impact of adversity hold promise for creating tailored interventions for at-risk, underserved populations. Finally, to better understand the role of neighborhood factors in psychosocial stressors, we examined the relationship between neighborhood socioeconomic disadvantage and depression using data from the 2011-2014 National Health and Nutrition Examination Survey. We found that those living in neighborhoods with higher socioeconomic disadvantage was associated with greater depression severity and a greater likelihood of clinically relevant depression. However, this association was attenuated by individual-level socioeconomic status.