Neighborhood racial composition and hypertension awareness, treatment, and control: An examination of direct, mediating and moderating effects of economic and social factors

Non-Hispanic Blacks (NHBs) suffer disproportionate rates of hypertension. Although prevalence is frequently examined, racial/ethnic differences in hypertension awareness, treatment, and control are equally important, yet poorly understood. Compared with non-Hispanic Whites (NHWs) and Hispanics, NHBs are more likely to be aware of their hypertension, more likely to receive treatment, yet less likely to achieve control. Research has established that NHB neighborhood racial composition and poverty impact health; however, the mechanisms influencing hypertension awareness, treatment, and control are obscure.;This dissertation examines three main research questions. First, whether there is an association between NHB neighborhood racial composition and hypertension awareness, treatment and control, and, if so, the extent to which this association is explained by neighborhood socioeconomic composition. Next, whether social connectedness also explains this association. Finally, I examine perceived discrimination, in conjunction with NHB neighborhood racial composition, in shaping hypertension awareness, treatment and control.;To address these research questions, data were analyzed, from a sample of 377 hypertensive adults in Detroit, Michigan, using SAS 9.0 and two-level hierarchical regression models (HLM 7). NHB neighborhood racial composition was positively associated with awareness (OR = 1.01, p=0.05). No association was found between NHB neighborhood racial composition and treatment among those who were aware (OR=1.01, p=0.33), or of control among those who were treated (OR=1.00, p=0.73).;Analyses reported here did not support the hypothesis that social connectedness was associated with hypertension awareness, treatment, and control. Social connectedness was not associated with awareness (OR=1.34, p=0.08) nor did it mediate associations between NHB neighborhood racial composition and awareness. Similarly, social connectedness was not associated with treatment (OR=1.12, p=0.69), or control OR=1.00, p=1.00) among those currently treated for hypertension.;Individual acute unfair treatment modified associations between NHB neighborhood racial composition and hypertension awareness (OR=1.02, p=0.04), and individual acute unfair treatment positively correlated with being treated for hypertension (OR=9.13, p=0.001). Aggregate acute unfair treatment was not associated with achieving hypertension control (OR=0.22, p=0.10). Findings emphasize the importance of multilevel approaches examining social and economic factors in explaining racial /ethnic differences in hypertension awareness, treatment, and control. Policy solutions should focus on creating equitable neighborhoods for all races/ethnicities.