Background
Methods
Study population
Measures
Statistical analyses
Results
Primary analysis
Characteristics | Included (n = 6,086) | Excluded (n = 1,661) | P-value* | ||
---|---|---|---|---|---|
N | % | N | % | ||
Neighborhood social cohesion
†
at Exam 1
| |||||
Low | 2,078 | 34.1 | 382 | 23.0 | < 0.01 |
Medium | 2,455 | 40.3 | 502 | 30.2 | |
High | 1,553 | 25.5 | 777 | 46.8 | |
Age
‡
in years at Exam 1
| 61 (53–69) | 53 (44–62) | < 0.01 | ||
Sex/gender at Exam 1
| |||||
Female | 3,145 | 51.7 | 1,066 | 64.2 | < 0.01 |
Male | 2,941 | 48.3 | 595 | 35.8 | |
Race/ethnicity at Exam 1
| |||||
White non-Hispanic | 2,288 | 37.6 | 0 | 0 | < 0.01 |
Asian | 1,081 | 17.8 | 15 | 0.9 | |
African American | 1,460 | 24.0 | 1,646 | 99.1 | |
Hispanic | 1,257 | 20.7 | 0 | 0 | |
Nativity at Exam 1
| |||||
Other | 2,145 | 35.2 | 15 | 0.9 | < 0.01 |
U.S.-born | 3,941 | 64.8 | 1,646 | 99.1 | |
Region at Exam 1
| |||||
West | 1,126 | 18.5 | 0 | 0 | < 0.01 |
South | 870 | 14.3 | 1,646 | 99.1 | |
Midwest | 2,325 | 38.2 | 15 | 0.9 | |
Northeast | 1,765 | 29.0 | 0 | 0 | |
Marital Status at Exam 1
| |||||
Never married, separated/divorced, widowed | 2,178 | 35.8 | 671 | 40.4 | < 0.01 |
Married | 3,908 | 64.2 | 990 | 59.6 | |
Self-rated health
§
at Exam 1
| |||||
Not good | 542 | 8.9 | 401 | 24.1 | < 0.01 |
Good | 5,544 | 91.1 | 1,260 | 75.9 | |
Health Insurance at Exam 1
| |||||
None | 509 | 8.4 | 206 | 12.4 | < 0.01 |
Public or Private | 5,577 | 91.6 | 1,455 | 87.6 | |
Family history of CVD and stroke at Exam 1
| |||||
No | 2,676 | 44.0 | 692 | 41.7 | 0.09 |
Yes | 3,410 | 56.0 | 969 | 58.3 | |
Education at Exam 1
| |||||
Less than high school | 949 | 15.6 | 156 | 9.4 | < 0.01 |
High school or some college | 2,675 | 44.0 | 766 | 46.1 | |
College degree or more | 2,462 | 40.5 | 739 | 44.5 | |
Employment at Exam 1
| |||||
Unemployed | 3,002 | 49.3 | 639 | 38.5 | < 0.01 |
Employed (Part/full-time) | 3,084 | 50.7 | 1,022 | 61.5 | |
Income at Exam 1
| |||||
$0-$19,999 | 1,299 | 21.3 | 364 | 21.9 | 0.88 |
$20,000-$49,999 | 2,181 | 35.8 | 593 | 35.7 | |
$50,000+ | 2,606 | 42.8 | 704 | 42.4 | |
Anger
†
at Exam 1
| |||||
Low | 2,410 | 39.6 | 499 | 30.0 | < 0.01 |
Medium | 2,053 | 33.7 | 433 | 26.1 | |
High | 1,623 | 26.7 | 729 | 43.9 | |
Depressive symptoms (CES-D ≥ 16) at Exam 1
| |||||
No | 5,344 | 87.8 | 1,315 | 79.2 | < 0.01 |
Yes | 742 | 12.2 | 346 | 20.8 | |
Chronic stress
†
at Exam 1
| |||||
Low | 3,064 | 50.4 | 280 | 16.9 | < 0.01 |
Medium | 1,960 | 32.2 | 650 | 39.1 | |
High | 1,062 | 17.5 | 731 | 44.0 | |
Discrimination
†
at Exam 1
| |||||
Low | 2,431 | 39.9 | 365 | 22.0 | < 0.01 |
Medium | 2,076 | 34.1 | 500 | 30.1 | |
High | 1,579 | 25.9 | 796 | 47.9 | |
Neighborhood deprivation
†
at Exam 1
| |||||
Low | 1,471 | 24.2 | 822 | 49.5 | < 0.01 |
Medium | 2,186 | 35.9 | 495 | 29.8 | |
High | 2,429 | 39.9 | 344 | 20.7 | |
Neighborhood safety at Exam 1
| |||||
Safe | 5,193 | 85.3 | 995 | 59.9 | < 0.01 |
Not safe | 893 | 14.7 | 666 | 40.1 | |
Social support at Exam 1
| |||||
Not high | 2,322 | 38.2 | 425 | 25.6 | < 0.01 |
High | 3,764 | 61.9 | 1,236 | 74.4 |
Outcome | Neighborhood social cohesion and visit product term in outcome model | High versus low neighborhood social cohesion PR (95% CI) | Medium versus low neighborhood social cohesion PR (95% CI) | |||
---|---|---|---|---|---|---|
Unadjusted
|
Adjusted
†
|
Unadjusted
|
Adjusted
†
| |||
Primary (n = 6,086)
| ||||||
Ideal or intermediate versus poor CVH | Without product term | 1.06 (1.01–1.10) | 1.01 (0.97–1.05) | 1.07 (1.03–1.11) | 1.02 (0.98–1.06) | |
With product term‡ | Visit 1 | 1.06 (1.01–1.10) | 1.01 (0.96–1.05) | 1.08 (1.01–1.12) | 1.02 (0.98–1.06) | |
Visit 2 | 1.06 (0.99–1.12) | 1.02 (0.96–1.08) | 1.06 (1.03–1.12) | 1.02 (0.96–1.07) | ||
Secondary (n = 7,291)
| ||||||
Ideal or intermediate (but no poor) metrics versus 1 or more poor metrics | Without product term | 1.00 (0.93–1.08) | 1.01 (0.95–1.09) | 1.06 (1.00-1.13) | 1.01 (0.95–1.07) | |
With product term§ | Visit 1 | 0.99 (0.92–1.07) | 1.02 (0.95–1.09) | 1.04 (0.98–1.11) | 0.99 (0.93–1.05) | |
Visit 2 | 1.03 (0.94–1.12) | 1.00 (0.92–1.10) | 1.09 (1.01–1.19) | 1.03 (0.95–1.12) | ||
Lower cardiovascular risk (0–1 poor metrics) versus non-lower cardiovascular risk (2–4 poor metrics) | Without product term | 0.99 (0.97–1.02) | 0.99 (0.97–1.02) | 1.03 (1.00-1.05) | 1.01 (0.98–1.03) | |
With product term¶ | Visit 1 | 0.99 (0.96–1.02) | 0.99 (0.96–1.03) | 1.03 (1.01–1.06) | 1.01 (0.99–1.04) | |
Visit 2 | 1.01 (0.97–1.04) | 0.99 (0.96–1.03) | 1.01 (0.98–1.04) | 0.99 (0.96–1.02) |
Psychosocial risk measure (Potential effect measure modifier) | High versus low neighborhood social cohesion and ideal or intermediate versus poor CVH by level of psychosocial risk measure | Medium versus low neighborhood social cohesion and ideal or intermediate versus poor CVH by level of psychosocial risk measure | p† | |||
---|---|---|---|---|---|---|
aPR
|
95% CI
|
aPR
|
95% CI
| |||
Education at Exam1
| ||||||
College degree or more | 1.05 | (1.00-1.10) | 1.04 | (0.99–1.09) | < 0.01 | |
High school or some college | 1.05 | (0.98–1.12) | 1.03 | (0.96–1.09) | ||
Less than high school | 0.77 | (0.67–0.88) | 0.98 | (0.89–1.08) | ||
Employment at Exam1
| ||||||
Employed | 1.02 | (0.96–1.08) | 1.02 | (0.96–1.08) | 0.81 | |
Unemployed | 1.00 | (0.95–1.06) | 1.02 | (0.97–1.08) | ||
Income at Exam1
| ||||||
$50,000+ | 1.03 | (0.98–1.08) | 1.01 | (0.96–1.07) | 0.33 | |
$20,000-$49,999 | 0.99 | (0.92–1.06) | 1.01 | (0.95–1.07) | ||
$0-$19,999 | 0.98 | (0.88–1.09) | 1.07 | (0.99–1.15) | ||
Anger at Exam1
| ||||||
Low | 1.03 | (0.97–1.09) | 1.04 | (0.98–1.10) | 0.51 | |
Medium | 1.01 | (0.96–1.07) | 0.99 | (0.94–1.05) | ||
High | 0.98 | (0.90–1.06) | 1.03 | (0.96–1.11) | ||
Depressive symptoms at Exam1
| ||||||
No | 1.02 | (0.97–1.06) | 1.02 | (0.98–1.06) | 0.71 | |
Yes | 0.96 | (0.84–1.10) | 1.03 | (0.93–1.14) | ||
Chronic stress at Exam1
| ||||||
Low | 1.02 | (0.96–1.07) | 1.04 | (0.99–1.08) | 0.88 | |
Medium | 1.00 | (0.93–1.07) | 1.00 | (0.93–1.07) | ||
High | 1.03 | (0.94–1.13) | 1.01 | (0.92–1.11) | ||
Discrimination at Exam1
| ||||||
Low | 0.96 | (0.91–1.02) | 0.99 | (0.94–1.04) | 0.12 | |
Medium | 1.02 | (0.96–1.09) | 1.02 | (0.96–1.07) | ||
High | 1.08 | (1.01–1.15) | 1.08 | (1.01–1.15) | ||
Neighborhood deprivation at Exam1
| ||||||
Low | 0.99 | (0.89–1.09) | 1.01 | (0.93–1.09) | 0.67 | |
Medium | 1.00 | (0.93–1.08) | 1.04 | (0.97–1.11) | ||
High | 1.03 | (0.98–1.08) | 1.02 | (0.97–1.06) | ||
Neighborhood safety at Exam1
| ||||||
Safe | 1.00 | (0.96–1.04) | 1.01 | (0.97–1.06) | 0.35 | |
Not safe | 1.09 | (0.98–1.21) | 1.05 | (0.97–1.15) |