Leveraging Spatial Epidemiology to Reduce Hypertension Disparities

PROJECT SUMMARY
Hypertension affects half of American adults but poses an especially severe burden on African Americans.
Disparities in hypertension diagnosis, treatment, and control outcomes are spatially patterned. This spatial
patterning is hypothesized to be due to area-level socioeconomic risk factors and area-level structural resources
(e.g., healthy foods, recreation, healthcare, and housing). Leveraging detailed spatial data provides unique
opportunities to drill down below common area-level studies and elucidate the mechanisms by which area-level
factors produce hypertension disparities. Spatial social polarization (SSP) indices are potentially key to
understanding hypertension disparities. SSP indices measure the extent to which populations are distributed at
extremes of privilege and deprivation of socioeconomic domains. SSP indices can be meaningfully expanded to
measure structural resources, representing key opportunities to examine hypertension disparities. Despite such
promise, little research has evaluated the association between socioeconomic SSP and hypertension; and no
prior research has quantified structural SSP or its relationship with hypertension disparities. The scientific
objective of this proposal is to estimate the impact of eight SSP domains on hypertension disparities, evaluating
both socioeconomic SSP (race/ethnicity, income, education, residential segregation) and structural SSP (food,
recreation, healthcare, and housing) domains. The central hypothesis is that living in areas with high SSP
increases hypertension disparities. This innovative project will leverage data from (1) the Cardiovascular Health
Study (CHS); (2) the REasons for Geographic and Racial Differences in Strokes (REGARDS) study; (3) private
and public claims data from Optum and Medicare; and (4) spatial data from the Retail Environment and
Cardiovascular Disease (RECVD) study with geographic linkages to CHS and REGARDS cohorts. Research
aims will (1) estimate the population-level effects of socioeconomic SSP predictors of hypertension prevalence,
incidence, treatment, and control outcomes among Black and White adults; (2) develop a structural SSP index
using measures of structural resources, and estimate the association between structural SSP and hypertension
among Black and White adults; and (3) evaluate the extent to which socioeconomic and structural SSP mediate
Black-White hypertension disparities. This research plan is complemented by a training plan that builds on the
applicant’s background in epidemiology and biostatistics. The training plan includes measuring and modeling
hypertension-specific SSP in diverse populations, analyzing large claims data, and applying causal inference
methods. The combined research and training plans will prepare the applicant for a successful independent
research career in epidemiology. The proposed research will improve public health surveillance of hypertension
disparities, provide the evidence required to inform the development of SSP interventions, and invite further
research on the causal pathways linking concentrations of privilege and deprivation to health disparities.

Grant Number: 5R00HL161479-04
NIH Institute/Center: NIH
Principal Investigator: Hoda Abdel Magid