Disparities in Cardiovascular Disease Risk: Neighborhood Segregation and Poverty

描述(由申请人提供)：尽管心血管疾病(CVD)在过去30年中有所下降，但心血管疾病仍然是美国人的主要死亡原因，并对发病率和残疾有很大贡献(US DHHS 2000)。不同种族和社会经济地位的疾病及其风险因素的流行率存在显著差异，风险因素随时间的改善也不均衡(美国国土安全部，2000年；坎吉拉尔，2006年；门萨，2005年；库里安，2007年)。虽然心血管疾病中的种族差异得到了很好的记录，但其原因没有得到很好的理解，社会经济地位和居住隔离的混杂影响也没有在文献中得到充分的解释(LaVeist 2005；LaVeist等人)。即将推出)。居住隔离和集中贫困都被认为是造成心血管疾病种族差异的直接因素的基本社会决定因素(Kanjilal，2006；Mensah，2005)。然而，很少有研究对这一命题进行实证检验(Acevedo-Garcia等人。2003年)。在这项研究中，我们建议使用国家健康和营养检查调查(NHANES)和2000年人口和住房普查汇总文件3中的普查区域水平数据。我们将检验心血管疾病危险因素与居住隔离和集中贫困之间的关系，并估计这些因素对种族差异的贡献。要检查的临床心血管危险因素包括：高血压、糖尿病、高脂血症、心血管健康和肥胖。行为风险因素将包括体育活动、吸烟、饮酒、营养和筛查做法。最后，我们将探讨居民特征，如食品店的可获得性、医疗保健提供者和是否适合步行，是否调解隔离、集中贫困和心血管疾病风险因素之间的关系。公共卫生相关性：该项目将研究心血管疾病的临床和行为风险因素中种族差异的社会决定因素。该项目旨在关注种族居住隔离和集中贫困与高血压、糖尿病、高脂血症、心血管健康和肥胖症之间的联系，以及体育活动、吸烟、饮酒、营养和筛查做法。此外，该项目将评估种族居住隔离和集中贫困在多大程度上导致了这些风险因素中的种族差异，以及这些社区的哪些特征对心血管健康产生了负面影响。

DESCRIPTION (provided by applicant): Despite declines in cardiovascular disease (CVD) over the past 30 years, CVD remains the leading cause of death for Americans and contributes substantially to morbidity and disability (US DHHS 2000). Significant disparities exist in the prevalence of disease and its risk factors by race and socio-economic position and improvements in risk factors over time has been uneven (US DHS 2000; Kanjilal 2006; Mensah 2005; Kurian 2007). While racial disparities in CVD are well documented, their etiology is not well understood and the confounding effects of socio-economic position and residential segregation are not adequately accounted for in the literature (LaVeist 2005; LaVeist et al. forthcoming). Both residential segregation and concentrated poverty have been posited to be fundamental social determinants of proximate factors that produce racial disparities in CVD (Kanjilal 2006; Mensah 2005). However, few studies have tested this proposition empirically (Acevedo-Garcia et al. 2003). In this study, we propose to use the National Health and Nutrition Examination Survey (NHANES) merged with census tract level data from the 2000 Census of Population and Housing Summary File 3. We will examine the association between CVD risk factors and both residential segregation and concentrated poverty and estimate the contribution of these factors to racial disparities. Clinical CVD risk factors to be examined will include: hypertension, diabetes, hyper-lipidemia, cardiovascular fitness, and obesity. Behavioral risk factors will include physical activity, smoking, alcohol use, nutrition, and screening practices. Finally, we will explore whether residential characteristics such as availability of food store outlets, health care providers, and walkability mediate the relationship between segregation, concentrated poverty and CVD risk factors. PUBLIC HEALTH RELEVANCE: This project will examine the social determinants of racial disparities in clinical and behavioral risk factors for cardiovascular disease. The project is designed to focus on the association between racial residential segregation and concentrated poverty on hypertension, diabetes, hyperlipidemia, cardiovascular fitness, and obesity and on physical activity, smoking, alcohol use, nutrition, and screening practices. In addition, the project will assess the extent to which racial residential segregation and concentrated poverty account for race disparities in these risk factors and what characteristics of such neighborhoods negatively impact cardiovascular health.