The stress pathway: a proposed link between neighborhood disorder and cardiovascular disease

Amie Devlin

doi:10.17918/00001399

Introduction: Research suggests that neighborhood disorder may contribute to racial inequities in cardiovascular health, with some hypothesizing that this relationship is mediated through the psychological and physiological stress response. This study investigated the stress pathway by quantifying the role of both the psychological and the physiological stress response in the relationship between neighborhood disorder and CVD. Methods: This study utilized data from the Jackson Heart Study (JHS), a longitudinal cohort of Black residents of the Jackson, Mississippi metropolitan area. We began by conducting a mediation analysis to examine the role of self-reported neighborhood stress in the relationship between neighborhood disorder and CVD. We then examined the relationship between self-reported neighborhood stress and the physiological stress response (quantified using high-sensitivity C-Reactive Protein/CRP), with an explicit focus on gender as a potential effect modifier. Finally, we assessed the physiological stress response (i.e., CRP) as an intermediary between neighborhood disorder and CVD. Results: Our mediation analysis investigating self-reported neighborhood stress as a mediator between neighborhood disorder and CVD produced conflicting results; though there was some evidence supporting neighborhood stress as a mediator between neighborhood disorder and cardiovascular disease, those results are potentially skewed by our operationalization of neighborhood stress. In our next analysis, presence of weekly neighborhood stress was associated with a 14.8% increase in CRP for women and a 12.7% decrease for men, though no associations were seen for yearly neighborhood stress. Similarly, there was no association between neighborhood stress and high (vs. low) CRP. In our final analysis, CRP did not serve as a mediator between neighborhood disorder and CVD. This result was driven by the lack of an association between neighborhood disorder and CRP. Conclusions: This study provided preliminary evidence supporting the relationship between neighborhood stress and CRP; however, the findings from other aspects of our analysis were largely inconclusive. This highlights the complexities surrounding the quantification of neighborhood stress. Future research into this topic area should take strides to include a more robust measurement of self-reported neighborhood stress.

The stress pathway: a proposed link between neighborhood disorder and cardiovascular disease

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The stress pathway: a proposed link between neighborhood disorder and cardiovascular disease

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