Neighborhood Indices, Income, and Cardiovascular-Kidney-Metabolic Syndrome at the Census Tract Level.

Area of Science:

• Public Health
• Social Epidemiology
• Health Disparities

Background:

• Several neighborhood-level indices exist in the US to assess socioeconomic and environmental factors.
• Direct comparisons of these indices for their association with cardiovascular-kidney-metabolic (CKM) conditions are limited.
• The added value of these indices beyond traditional measures like income is not well understood.

Purpose of the Study:

• To evaluate the variability explained by seven neighborhood indices in the prevalence of CKM conditions at the census tract level.
• To determine the incremental value of each index when added to median household income.
• To compare the performance of various neighborhood indices in capturing place-based disparities in CKM conditions.

Main Methods:

• Cross-sectional study utilizing US national surveillance data (BRFSS, ACS) from 2010-2022.
• Included 65,476 US census tracts with complete data.
• Analyzed seven neighborhood indices (e.g., Area Deprivation Index, Social Vulnerability Index) and median household income.
• Assessed index agreement using Spearman correlations and incremental variability using change in R-squared.

Main Results:

• All neighborhood indices and median household income were significantly associated with the prevalence of coronary heart disease (CHD), stroke, and chronic kidney disease (CKD).
• Indices and income showed modest to high correlations (0.46-0.94), with some discordance in tract classification.
• The Structural Racism Effect Index demonstrated the highest incremental variability explained for stroke (change in R2 = 0.195), while the Environmental Justice Index showed the least for CHD (change in R2 = 0.014).

Conclusions:

• Neighborhood indices and median household income exhibit similar associations with CKM condition prevalence.
• These place-based measures provide valuable, sometimes incremental, information for understanding and addressing health disparities.
• Findings support the application of diverse neighborhood indices in public health research and policy.