Abstract 6217: Understanding Geographic Variation in Hypertension Prevalence among African Americans: The Multi-Ethnic Study of Atherosclerosis
African Americans are heterogeneous in cardiovascular risk. Several studies have noted a geographic pattern of cardiovascular risk and cardiovascular risk factors such as hypertension among African Americans. Understanding the causes of geographic differences in hypertension may provide insights into social and environmental causes of hypertension. There are geographic differences in hypertension prevalence among African Americans by place of birth and place of residence in adulthood. These differences are due to differences in socioeconomic characteristics and living environments. 1352 African American participants of the Multi-Ethnic Study of Atherosclerosis were classified into four groups based on cross classification of place of birth and place of residence in adulthood (US South vs. non-South), using US Census definitions. We used Poisson regression to estimate the association between region of birth-residence and hypertension prevalence. Individual level income and education, parental education, 20-year mean neighborhood poverty, and the neighborhood social (safety and social cohesion) and physical (walkability and healthy food availability) environments were examined as potential explanations for geographic differences. Blacks born and living in the South, as well as Blacks who migrated into the South, had a higher prevalence of hypertension compared to those born and living outside the South, even after adjustment for socioeconomic characteristics and neighborhood poverty (see table⇓). Associations were attenuated after adjustment for the neighborhood physical environment, which was inversely associated with hypertension prevalence. These associations persisted after further adjustment for individual-level covariates. Differences in neighborhood characteristics may contribute to the geographic patterning of hypertension in African Americans.