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CVD仍然是美国人死亡的主要原因，并在很大程度上导致发病率和残疾（美国DHHS 2000）。不同种族和社会经济地位的疾病患病率及其风险因素存在显著差异，而且随着时间的推移，风险因素的改善并不均衡（美国国土安全部，2000年；Kanjilal， 2006年；Mensah， 2005年；Kurian， 2007年）。虽然心血管疾病的种族差异有很好的记录，但其病因尚不清楚，文献中也没有充分考虑社会经济地位和居住隔离的混淆效应（LaVeist 2005； LaVeist等人即将出版）。居住隔离和集中贫困都被认为是导致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 et al. 2003）。在本研究中，我们建议使用国家健康和营养检查调查（NHANES）与2000年人口和住房普查摘要文件3中的人口普查区水平数据合并。我们将研究心血管疾病风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。需要检查的临床心血管疾病危险因素包括：高血压、糖尿病、高脂血症、心血管健康和肥胖。行为风险因素包括身体活动、吸烟、饮酒、营养和筛查做法。最后，我们将探讨居住特征，如食品商店网点、医疗服务提供者和步行性是否介导隔离、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。该项目旨在重点关注种族居住隔离与高血压、糖尿病、高脂血症、心血管健康和肥胖之间的联系，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造成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.