Does Neighborhood Disadvantage Affect Subclinical Atherosclerosis?

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Background: Cardiovascular health disparities across subpopulations and geographies have been well-documented in urban areas. Evidence suggests that racial minorities and low-socioeconomic groups have high risks of developing cardiovascular diseases (CVD). Residents of the Appalachia also exhibit high rates of CVD, but little is known about the relationships between cardiovascular risk factors, spatial disadvantage, and cardiovascular health outcomes in this region. Thus, this study aimed to examine the independent association between neighborhood factors and subclinical atherosclerosis in an asymptomatic population from central Appalachia. Methods: Community-dwelling asymptomatic individuals (n=210) were screened for Coronary Artery Calcium (CAC), a subclinical marker for coronary atherosclerosis, from January 2010 to January 2014. Based on the standard Agatston Scale, participants were grouped into 4 CAC scores: zero (CAC = 0), mild (CAC = 1-99), moderate (CAC = 100-399) and severe (CAC ≥ 400) to determine the severity of coronary artery disease (CAD). Demographic information (e.g., age, gender, race, and marital status), cardiovascular risk factors (e.g., hypertension, hypercholesterolemia, obesity, smoking, and family history of CAD), and neighborhood level characteristics (racial and socioeconomic characteristics of the population) were used in ordinal logistic regression analyses performed in Stata 14.1. Results: Of the 210 participants, over three-fourths (79%) had a CAC score greater than 1. While 67% of the participants were hypertensive, 80% had hypercholesterolemia, 75% were overweight or obese, 52% had a history of smoking, and 55% had a family history of CAD. There were significant differences in the socioeconomic environment of these residents. Specifically, zip-code median household income was higher for individuals with zero CAC score. Additionally, the zip-code household poverty percentage was higher for those with CAC scores ≥ 1. Although all the neighborhood factors increased the odds of having higher CAC score, none of them were statistically significant. Conclusion: The positive, albeit statistically non-significant, association of adverse neighborhood factors with higher CAC scores suggests the need for larger studies for further understanding of this association. Finally, achieving the Healthy People 2020 goal of reducing or eliminating disparities requires risk factor screening and control in high prevalent areas such as central Appalachia, and understanding the neighborhood level dynamics for CVD.


Denver, CO

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