Association of Neighborhood Violent Crime With Hypertension-Related Emergency Department Visits in Chicago

Living in neighborhoods with a greater burden of violence is associated with higher cardiovascular disease risk. However, the interpretation of place-based findings is impeded by methodological challenges. To address challenges related to the influence of correlated neighborhood exposures, we utilized a case-crossover design to examine whether patients were more likely to have experienced a violent crime in their neighborhood during the month before their hypertension-related emergency department (ED) visit, compared with control periods 1 year before and after.

Participants were patients who made ED visits to a single hospital in the Northwestern Medicine Health System between 2016 to 2019 and had a valid address in Chicago. Neighborhood violent crime was quantified at the block group level and modeled as both a dichotomous exposure (testing for an absolute effect, where any crime increases hypertension risk) and a continuous exposure (testing for a relative effect, where crime increases relative to the area norms increase hypertension risk). The primary outcome was a hypertension-related ED visit. Conditional logistic regression (without covariate adjustment) was the principal analytic method.

The sample (N=22 173) had a mean age = 66.0 years and was 52.7% female; 39.9% White, 35.7% Black, 12.4% Hispanic. Among the patients, 51.5% lived in block groups where a violent crime occurred in the month before the ED visit (ie, case period); 50.7% lived in block groups where a violent crime occurred during the control periods. Neighborhood violent crime was associated with a greater likelihood of a hypertension-related ED visit, both when observing absolute changes in violent crime (odds ratio, 1.05 [95% CI, 1.01-1.09]) and relative changes in violent crime (odds ratio, 1.03 [95% CI, 1.01-1.05]).

This research has clinical and policy implications related to the importance of public safety and the potential cardiovascular-related risks following exposure to neighborhood violent crime.