Exposure to Changing Neighborhood Conditions and Cardiovascular Health Across the Menopausal TransitionSchiff, Mary Denise (2023) Exposure to Changing Neighborhood Conditions and Cardiovascular Health Across the Menopausal Transition. Doctoral Dissertation, University of Pittsburgh. (Unpublished)
AbstractAs the leading cause of death among women in the United States (US), cardiovascular disease (CVD) remains a critical public health concern. Neighborhood social, economic, and housing conditions influence cardiovascular health, yet studies utilizing longitudinal data, samples of midlife women, annually collected residential histories, and time-varying neighborhood exposures remain limited. We used data on 2,833 participants from the Study of Women’s Health Across the Nation (SWAN) living in six US cities during 1996-2007 for this work. In Aim 1, we used longitudinal latent profile analysis to identify distinct patterns of neighborhood socioeconomic vulnerability occurring among participant neighborhoods across the decade. We then used linear mixed-effect models to assess the relationship between neighborhood profiles and blood pressure trajectories among women across ten-year follow-up. We found that longitudinal exposure to neighborhood socioeconomic vulnerability during midlife accelerated systolic blood pressure increases among women over time. In Aim 2, we used the local Getis-Ord Gi* spatial statistic to identify geographic clusters (cold-spots & hot-spots) of neighborhood concentrated poverty within each local SWAN region over time. We then used linear mixed-effect models to assess the relationship between neighborhood concentrated poverty and adiposity levels among women across midlife. We found that longitudinal exposure to neighborhood concentrated poverty throughout midlife was associated with higher body mass index and waist circumference levels among women across ten-year follow-up. In Aim 3, we investigated whether cumulative exposure to neighborhood poverty throughout midlife predicted subclinical cardiovascular disease burden among women in subsequent years. We used marginal structural models with inverse probability weighting to address time-varying confounding and loss-to-follow-up biases in our longitudinal cohort over time. We found that long-term exposure to neighborhood poverty across midlife was associated with greater carotid intima media thickness and inter-adventitial diameter levels among women in early older-age. Our findings suggest that women exposed to neighborhood economic hardship throughout midlife may experience poorer cardiovascular health, above and beyond individual-level risk factors. Our work emphasizes the value of targeting socioeconomically vulnerable communities for evidence-based revitalization efforts, community-based participatory outreach, and policy-work to stimulate economic growth as potential avenues to reduce disparities in CVD morbidity and mortality among women. Share
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