Assessing neighborhood-level effects on disparities in cardiovascular diseases.

Despite declines in mortality from cardiovascular diseases (CVDs) and many CVD risk factors, CVD remains the leading cause of death in the United States, and racial and ethnic disparities persist. In 2010, rates of CVD mortality per 100 000 were: 192.2 for white women; 260.5 for black women; 278.4 for white men; and 369.2 for black men. 1 In 2009 and 2010, metrics of ideal cardiovascular health factors (ie, blood pressure, physical activity, healthy diet, healthy weight, smoking status, and glucose) were noted to be lower for blacks and Mexican Americans than for whites or other racial groups. 1 In 2012, the following age-adjusted prevalence estimates among nonwhite adult populations were noted compared with the white population: 2 (1) the prevalence of heart disease and coronary heart disease (CHD) was similar in blacks, lower in Hispanics and Asians, and higher in American Indians/ Alaska natives, and native Hawaiian or other Pacific Island populations; (2) the prevalence of hypertension was higher in blacks, similar or lower in Hispanics and Asians, and higher in American Indians/Alaska natives, and native Hawaiian or other Pacific island populations; and (3) the prevalence of having had a stroke was higher in blacks, lower in Hispanics, and lower in Asian populations. The persistence of racial and ethnic disparities in CVD is a major public health problem that calls for more understanding of root causes that may inform evidence-based deliberations and policies. Studies have shown that racial and ethnic disparities in CVD: (1) appear to remain after adjusting for known individual-level risk factors such as blood pressure, smoking, body mass index (BMI), and socioeconomic status (SES); 3 and (2) tend to vary with age, time, and geography. These observations suggest that neighborhood-level social or environmental factors not captured by conventional measures of SES (eg, neighborhood segregation, discrimination, perceptions of neighborhood) need to be considered as potential drivers of such disparities and as priority areas for population-based research. Within this context, one factor that has received increasing attention in epidemiological research is racial/ethnic residential segregation, defined as " the degree to which two or more racial/ethnic groups live separately from one another. " 6 The study by Kershaw et al. 7 in this issue of Circulation is important in this regard. Based on data from the Multi-Ethnic Study of Atherosclerosis (MESA), and a novel measure of neighborhood residential segregation, the study shows associations between racial/ethnic residential segregation and an …