Introduction:The AHA’s Life’s Simple 7 (LSS) assesses cardiovascular health. Neighborhood socioeconomic status (N-SES) influences health; however, data are limited on racial differences in the association of N-SES and LSS.
Hypothesis:Higher N-SES is associated with better LSS status similarly in whites and blacks.
Methods:We studied 9,899 black and white participants aged 45+ without CVD from across the US. The 7 LSS metrics (blood pressure, cholesterol, glucose, BMI, smoking, physical activity, diet) were scored as poor, intermediate or ideal. N-SES was indexed by a composite score of 7 measures of wealth and education. The association of N-SES with both ideal health (vs intermediate or poor) and poor health (vs intermediate or ideal) was assessed adjusting for age and sex, and additional adjustment for individual SES (I-SES as income and education).
Results:In whites, higher N-SES was associated with both higher ideal and lower poor status for 4 of the LSS metrics, with the remaining 3 associated with either higher ideal or lower poor status (figure). In blacks, only 1 LSS metric was associated with both higher ideal and lower poor status, 3 associated with either higher ideal or lower poor status, and there was no association in 3 metrics. After adjustment for I-SES, in whites N-SES remained associated with both higher ideal and lower poor status for 3 metrics, either higher ideal or lower poor in 3 metrics, and no association in 1 metric; however, in blacks, only 1 metric was associated with either ideal or poor status, no association for 5 metrics, and 1 metric with higher N-SES was associated with higher poor status.
Conclusions:Higher N-SES was strongly associated with better LSS status in whites, even after adjustment for I-SES. However, the association between N-SES with better LSS status was much weaker in blacks, and was largely attenuated with adjustment for I-SES. With regard to LSS, place matters for whites, but plays a much smaller role for blacks.