Place Matters: Investigating the Social and Environmental Drivers of Hypertension in Nashville

Hypertension disparities persist across communities, driven by interactions between social determinants of health (SDOH) and behavioral factors. This study examines geographic and demographic patterns of hypertension in Nashville, Tennessee, to assess how socioeconomic, environmental, and behavioral factors contribute to inequities in prevalence, treatment, and control. Granular ZIP code-level analyses highlight community-specific drivers and the need for policy reforms to advance health equity.

Using 2022 data from the U.S. Census Bureau's American Community Survey and CDC PLACES, we analyzed 199 Nashville ZIP codes. K-means clustering identified five population clusters. Lower-income clusters (e.g., Hardship Heartland: 37.2% hypertension prevalence; Urban Renters: 33.7%) exhibited elevated physical inactivity (30.9%), insufficient sleep (38.9%), smoking (22.6%), alongside limited healthcare access. Affluent clusters (Elite Enclaves: 30.8%) demonstrated better cardiovascular health. Non-Hispanic Black residents in urban cores faced disproportionately higher hypertension rates (35.4%) compared to non-Hispanic white residents in the same clusters (e.g., 43.8% white residents in Urban Renters).

Structural inequities-poverty, housing instability, and unequal healthcare access-drive hypertension disparities. Multi-sector interventions targeting upstream SDOH (e.g., affordable housing, equitable healthcare, and community wellness programs) are critical to reduce cardiovascular risk. Policy reforms prioritizing place based strategies in high-burden communities could mitigate disparities and improve population health.