Can I Buy My Health? A Genetically Informed Study of Socioeconomic Status and Health.

BACKGROUND: A large literature demonstrates associations between socioeconomic status (SES) and health, including physiological health and well-being. Moreover, gender differences are often observed among measures of both SES and health. However, relationships between SES and health are sometimes questioned given the lack of true experiments, and the potential biological and SES mechanisms explaining gender differences in health are rarely examined simultaneously. PURPOSE: To use a national sample of twins to investigate lifetime socioeconomic adversity and a measure of physiological dysregulation separately by sex. METHODS: Using the twin sample in the second wave of the Midlife in the United States survey (MIDUS II), biometric regression analysis was conducted to determine whether the established SES-physiological health association is observed among twins both before and after adjusting for potential familial-level confounds (additive genetic and shared environmental influences that may underly the SES-health link), and whether this association differs among men and women. RESULTS: Although individuals with less socioeconomic adversity over the lifespan exhibited less physiological dysregulation among this sample of twins, this association only persisted among male twins after adjusting for familial influences. CONCLUSIONS: Findings from the present study suggest that, particularly for men, links between socioeconomic adversity and health are not spurious or better explained by additive genetic or early shared environmental influences. Furthermore, gender-specific role demands may create differential associations between SES and health.

Obesogenic environments and cardiovascular disease: a path analysis using US nationally representative data.

INTRODUCTION: People living in obesogenic environments, with limited access to healthful food outlets and exercise facilities, generally have poor health. Previous research suggests that behavioral risk factors and indicators of physiological functioning may mediate this link; however, no studies to date have had the requisite data to investigate multi-level behavioral and physiological risk factors simultaneously. The present study conducted serial and parallel mediation analyses to examine behavioral and physiological pathways explaining the association between environmental obesogenicity and cardiovascular disease (CVD). METHODS: This cross-sectional observational study used data from the 2012-2016 Health and Retirement Study, a representative survey of US older adults (n = 12,482, mean age 65.9). Environmental obesogenicity was operationalized as a combined score consisting of nine environmental measures of food and physical activity. CVD and health-compromising behaviors (diet, alcohol consumption, smoking, and exercise) were self-reported. Physiological dysregulation was assessed with measured blood pressure, heart rate, HbA1c, cholesterol levels, BMI, and C-reactive protein. The Hayes Process Macro was used to examine serial and parallel paths through health-compromising behaviors and physiological dysregulation in the environmental obesogenicity-CVD link. RESULTS: People living in more obesogenic environments had greater odds of self-reported CVD (odds ratio = 1.074, 95% confidence interval (CI): 1.028, 1.122), engaged in more health-compromising behaviors (ß = 0.026, 95% CI: 0.008, 0.044), and had greater physiological dysregulation (ß = 0.035, 95% CI: 0.017, 0.054). Combined, health-compromising behaviors and physiological dysregulation accounted for 7% of the total effects of environmental obesogenicity on CVD. CONCLUSION: Behavioral and physiological pathways partially explain the environmental obesogenicity-CVD association. Obesogenic environments may stymie the success of cardiovascular health-promotion programs by reducing access to resources supporting healthy lifestyles.

Neighborhood Socioeconomic Status and Health: A Longitudinal Analysis.

Higher income neighborhoods are associated with better health, a relation observed in many cross-sectional studies. However, prior research focused on the prevalence of health conditions, and examining the incidence of new health conditions may provide stronger support for a potential causal role of neighborhoods on health. We used the 2004 and 2014 waves of the Midlife in the United States Study (n = 1726; ages 34-83) to examine health condition incidence as a function of neighborhood income. Among participants who had lived in the same neighborhood across the time period, we hypothesized that higher neighborhood income would be associated with a lower incidence of health conditions ten years later. Health included 18 chronic conditions related to mental (anxiety, depression) and physical (cardiovascular, immune) health. Multinomial logistic regression analyses adjusting for individual income and sociodemographics indicated that the odds of developing two or more new health conditions (no new health conditions as referent), was significantly lower (OR = 0.92, CI: 0.86, 0.99) for every $10,000 increment in neighborhood income. Associations did not vary by age or neighborhood tenure. Results add to a literature documenting that higher neighborhood income is associated with better health.

Perceived neighborhood disorder and type 2 diabetes disparities in Hispanic, Black, and White Americans.

Introduction: Approximately 32 million Americans have type 2 diabetes, and that number continues to grow. Higher prevalence rates are observed among certain subgroups, including members of marginalized racial/ethnic groups as well as residents of disordered neighborhoods (i.e., those with more trash and vandalism). Institutionalized discriminatory practices have resulted in disproportionate representation of marginalized racial/ethnic groups in disordered neighborhoods compared to non-Hispanic Whites. These neighborhood disparities may partially contribute to health disparities, given that signs of neighborhood disorder often relate to a general withdrawal from the neighborhood, minimizing opportunities for both physical and social engagement. Yet, research suggests variability across racial/ethnic groups both in reporting rates of neighborhood disorder and in the extent to which neighborhood disorder is interpreted as posing a threat to health and well-being. Methods: Using 2016-2018 Health and Retirement Study data (n = 10,419, mean age = 67 years), a representative sample of older US adults, this study examined the possibility of racial/ethnic differences in associations between perceived neighborhood disorder and type 2 diabetes risk. Participants reported their perceptions of neighborhood disorder and type 2 diabetes status. Weighted logistic regression models predicted type 2 diabetes risk by perceived neighborhood disorder, race/ethnicity, and their interaction. Results: Non-Hispanic Blacks and Hispanics had higher type 2 diabetes risk; these two groups also reported more disorder in their neighborhoods compared to non-Hispanic Whites. Perceiving more neighborhood disorder was associated with increased type 2 diabetes risk, but the interaction between race/ethnicity and disorder was not significant. Discussion: Findings from the current study suggest that the negative effects of perceiving neighborhood disorder, a neighborhood-level stressor, extend to increased type 2 diabetes risk.

Does crime trigger genetic risk for type 2 diabetes in young adults? A G x E interaction study using national data.

BACKGROUND: Living in neighborhoods perceived as disordered exacerbates genetic risk for type 2 diabetes (T2D) among older adults. It is unknown whether this gene-neighborhood interaction extends to younger adults. The present study aims to investigate whether crime, an objectively measured indicator of neighborhood disorder, triggers genetic risk for T2D among younger adults, and whether this hypothesized triggering occurs through exposure to obesity. METHODS: Data were from the Wave I (2008) National Longitudinal Study of Adolescent to Adult Health. A standardized T2D polygenic score was created using 2014 GWAS meta-analysis results. Weighted mediation analyses using generalized structural equation models were conducted in a final sample of 7606 adults (age range: 25-34) to test the overall association of T2D polygenic scores with T2D, and the mediating path through obesity exposure in low, moderate, and high county crime-rate groups. Age, sex, ancestry, educational degree, household income, five genetic principal components, and county-level concentrated advantage and population density were adjusted. RESULTS: The overall association between T2D polygenic score and T2D was not significant in low-crime areas (p = 0.453), marginally significant in moderate-crime areas (p = 0.064), and statistically significant in high-crime areas (p = 0.007). The mediating path through obesity was not significant in low or moderate crime areas (ps = 0.560 and 0.261, respectively), but was statistically significant in high-crime areas (p = 0.023). The indirect path through obesity accounted for 12% of the overall association in high-crime area. CONCLUSION: A gene-crime interaction in T2D was observed among younger adults, and this association was partially explained by exposure to obesity.

In the eyes of the beholder: Race, place and health.

Racial and ethnic health disparities are fundamentally connected to neighborhood quality. For example, as a result of historical systemic inequities, racial and ethnic minorities are more likely to live in neighborhoods with signs of physical disorder (e.g., graffiti, vandalism), and physically disordered environments have been noted to associate with increased risk for chronic illness. Degree of exposure to neighborhood disorder may alter peoples' perception of their neighborhoods, however, with those most exposed (e.g., historically marginalized racial/ethnic groups) perhaps perceiving less threat from signs of neighborhood disorder. The purpose of the present study was to examine the complex interrelationships between people and place by investigating whether exposure to neighborhood physical disorder relates to residents' (1) perceptions of neighborhood safety and (2) perceptions of their health, and (3) examining whether these links vary by race/ethnicity. Using 2016-2018 Health and Retirement Study (HRS) data, a representative sample of US adults aged 51 years and older (n = 9,080, mean age 68 years), we conducted a series of weighted linear regressions to examine the role of neighborhood disorder in relation to both perceived neighborhood safety and self-rated health. Results indicated that greater neighborhood physical disorder was statistically significantly related to feeling less safe among non-Hispanic Whites and Hispanics, but not non-Hispanic Blacks. Regarding self-rated health, neighborhood physical disorder was statistically significantly related to poorer health among all racial/ethnic groups. These findings suggest that, despite differential interpretation of neighborhood disorder as a threat to safety, this modifiable aspect of peoples' environment is related to poor health regardless of one's race/ethnicity.

Cognition in context: Pathways and compound risk in a sample of US non-Hispanic whites.

The population of individuals with cognitive impairment and dementia is growing rapidly, necessitating etiological investigation. It is clear that individual differences in cognition later in life have both genetic and multi-level environmental correlates. Despite significant recent progress in cellular and molecular research, the exact mechanisms linking genes, brains, and cognition remain elusive. In relation to cognition, it is unlikely that genetic and environmental risk factors function in a vacuum, but rather interact and cluster together. The purpose of the present study was to examine whether aspects of individual socioeconomic status (SES) explain the cognitive genotype-phenotype association, and whether neighborhood SES modifies the effects of genes and individual SES on cognitive ability. Using data from non-Hispanic White participants in the 2016 wave of the Health and Retirement Study, a national sample of United States adults, we examined links between a polygenic score for general cognition and performance-based cognitive functioning. In a series of weighted linear regressions and formal tests of mediation, we observed a significant genotype-phenotype association that was partially attenuated after including individual education to the baseline model, although little reductions were observed for household wealth or census tract-level percent poverty. These findings suggest that genetic risk for poor cognition is partially explained by education, and this pathway is not modified by poverty-level of the neighborhood.

Neighborhood safety concerns and daily well-being: A national diary study.

People living in unsafe neighborhoods often report poor health. The reasons for this are multi-faceted, but one possibility is that unsafe neighborhoods create a situation of chronic stress, which may deplete people's resources to cope with the daily stressors of life. How people respond to daily stressors (e.g., with increased self-reported negative affect and physical symptoms) is positively associated with health problems and may thus be one pathway linking perceptions of neighborhood safety to poor health. The current study investigated the relationship between neighborhood safety concerns, daily stressors, affective well-being, and physical health symptoms in a national sample of adults from the Midlife in the United States Study II (n = 1748). In 2004, participants reported neighborhood safety concerns and history of chronic stress exposure. Across eight days, they also reported daily stressors, physical symptoms and negative affect. Greater neighborhood safety concerns were associated with higher negative affect and more physical symptoms, adjusting for other sources of chronic stress. Moreover, lower perceived neighborhood safety was related to greater increases in negative affect and physical symptoms on days during which stressors were reported, even after accounting for established interactions between daily stressors and other sources of chronic stress. Exposure to neighborhoods perceived as unsafe is associated with poorer daily well-being and exacerbated responses to daily stressors, which may serve as an individual-level pathway contributing to poorer health among people living in neighborhoods perceived as unsafe.

What predicts how safe people feel in their neighborhoods and does it depend on functional status?

Feeling unsafe in one's neighborhood is related to poor health. Features of the neighborhood environment have been suggested to inform perceptions of neighborhood safety. Yet, the relative contribution of these features (e.g., uneven sidewalks, crime, perceived neighborhood physical disorder) on perceived neighborhood safety, particularly among people with disabilities who may view themselves as more vulnerable, is not well understood. We examined whether sidewalk quality assessed by third party raters, county-level crime rates, and perceived neighborhood disorder would relate to neighborhood safety concerns, and whether functional limitations would exacerbate these links. Using data from the 2012/2014 waves of the Health and Retirement Study (n = 10,653, mean age = 66 years), a national sample of older US adults, we demonstrate that those with and without functional limitations felt less safe in areas with more crime and perceived as more disordered. When considered simultaneously, however, only perceived disorder statistically significantly predicted safety concerns. Living in neighborhoods with better sidewalk quality was statistically significantly related to feeling less safe, but only among those with functional limitations. Sidewalk quality was not statistically significantly related to safety reports among those without functional limitations. To our knowledge, this study is among the first to examine multiple features of the neighborhood environment simultaneously in relation to perceived neighborhood safety. Our findings highlight the relative importance of perceived physical disorder, and that these perceptions relate to safety concerns. Replication of this research is needed to determine the robustness of these patterns, including rich data on pedestrian use and sidewalk proximity to roadways. Community-level interventions that simultaneously target the multifaceted features of the neighborhood environment that shape people's safety reports may be needed to reduce burden of health.

Perceived neighborhood cohesion buffers COVID-19 impacts on mental health in a United States sample.

OBJECTIVE: This study examined whether perceived neighborhood cohesion (the extent to which neighbors trust and count on one another) buffers against the mental health effects of the 2020 COVID-19 pandemic. METHODS: The XXX University National COVID-19 and Mental Health Study surveyed US adults (N = 3965; M age = 39 years), measuring depressive symptoms, staying home more during than before the 2020 pandemic, and perceived neighborhood cohesion. RESULTS: A series of linear regressions indicated that perceiving one's neighborhood as more cohesive was not only associated with fewer depressive symptoms, but also attenuated the relationship between spending more time at home during the pandemic and depressive symptoms. These relationships persisted even after taking into account several individual-level sociodemographic characteristics as well as multiple contextual features, i.e., median household income, population density, and racial/ethnic diversity of the zip codes in which participants resided. CONCLUSIONS: Neighborhood cohesion may be leveraged to mitigate pandemic impacts on depressive symptoms.

Perceived neighborhood social cohesion and cardiometabolic risk: a gene × environment study.

People living in socially cohesive neighborhoods generally have better health. We extend this research by evaluating the hypothesis that perceived neighborhood cohesion may influence health by attenuating genetic liability for cardiometabolic risk factors. Using data from the Health and Retirement Study (n = 6615; mean age 69.7), we conducted a gene × environment interaction study hypothesizing that perceived neighborhood cohesion would attenuate the link between polygenic scores for waist-to-hip ratio (WHR) and body mass index and a measure of multisystem cardiometabolic risk (systolic and diastolic blood pressure, heart rate, A1c, C-reactive protein, and total and high-density lipoprotein cholesterol). In support of the hypothesis, results indicated that among people perceiving low neighborhood cohesion, higher WHR polygenic scores were associated with greater cardiometabolic risk. In contrast, the genetic-cardiometabolic risk link was much attenuated among those living in neighborhoods perceived as socially cohesive. Our results support community-level interventions to enhance the social cohesiveness of individuals' neighborhoods which may provide health benefits by reducing the risks associated with known genetic risk factors.

A Genetically Informed Study of Neighborhoods and Health: Results From the MIDUS Twin Sample.

OBJECTIVES: To examine whether neighborhood income and neighborhood safety concerns influence multisystem physiological risk after adjusting for genetic and environmental selection effects that may have biased previous tests of this association. METHODS: We used structural equation modeling with a genetically informed sample of 686 male and female twin pairs in the Midlife in the United States Study II (2004). RESULTS: Controlling for additive genetic and shared environmental processes that may have biased neighborhood-health links in previous examinations, higher neighborhood safety concerns were associated with less physiological risk among women but not men. DISCUSSION: Our findings suggest a possible causal role of neighborhood features for a measure of physiological risk that is associated with the development of disease. Efforts to increase neighborhood safety, perhaps through increased street lighting or neighborhood watch programs, may improve community-level health.

Perceived neighborhood social cohesion and cardiometabolic risk: a gene × environment study.

People living in socially cohesive neighborhoods generally have better health. We extend this research by evaluating the hypothesis that perceived neighborhood cohesion may influence health by attenuating genetic liability for cardiometabolic risk factors. Using data from the Health and Retirement Study (n = 6,615; mean age 69.7), we conducted a gene × environment interaction study hypothesizing that perceived neighborhood cohesion would attenuate the link between polygenic scores for waist-to-hip ratio (WHR) and body mass index and a measure of multisystem cardiometabolic risk (systolic blood pressure [SBP] and diastolic blood pressure [DBP], heart rate, A1c, C-reactive protein, and total and high-density lipoprotein cholesterol). In support of the hypothesis, results indicated that among people perceiving low neighborhood cohesion, higher WHR polygenic scores were associated with greater cardiometabolic risk. In contrast, the genetic-cardiometabolic risk link was much attenuated among those living in neighborhoods perceived as socially cohesive. Our results support community-level interventions to enhance the social cohesiveness of individuals' neighborhoods which may provide health benefits by reducing the risks associated with known genetic risk factors.

Neighborhood cohesion, neighborhood disorder, and cardiometabolic risk.

Perceptions of neighborhood disorder (trash, vandalism) and cohesion (neighbors trust one another) are related to residents' health. Affective and behavioral factors have been identified, but often in studies using geographically select samples. We use a nationally representative sample (n = 9032) of United States older adults from the Health and Retirement Study to examine cardiometabolic risk in relation to perceptions of neighborhood cohesion and disorder. Lower cohesion is significantly related to greater cardiometabolic risk in 2006/2008 and predicts greater risk four years later (2010/2012). The longitudinal relation is partially accounted for by anxiety and physical activity.

Age, Rumination, and Emotional Recovery From a Psychosocial Stressor.

OBJECTIVES: Exposure to psychosocial stressors often elicits increases in negative affect and blood pressure (BP). Rumination, or thinking about a stressor after it passes, is associated with delayed recovery. Given that older age is associated with greater BP reactivity to psychosocial stressors, rumination may be more detrimental to the recovery of older adults than younger adults. The current study examined this question. We hypothesized that prolonged distress resulting from rumination has greater effects on the recovery of older than younger adults. METHOD: Fifty-two older (M = 69 years) and 61 younger (M = 21 years) adults were exposed to a lab stressor. Afterwards, participants were randomly assigned to a rumination condition (n = 58) or a no-instruction control condition (n = 55). RESULTS: Older participants in the rumination condition had delayed BP recovery relative to those in the control condition and all younger adults. Rumination did not influence affective recovery among any of the groups. DISCUSSION: Rumination delays BP recovery among older adults, suggesting age-specific risks associated with different types of emotion regulation strategies.

Vigilance at Home: Longitudinal Analyses of Neighborhood Safety Perceptions and Health.

Feeling unsafe in one's neighborhood is associated with poor health. This relation may be conferred through multiple pathways, including greater psychological distress and health behaviors that are associated with poorer health and perceptions of neighborhood safety. Women and older adults often report feeling less safe in their environments despite having a lower risk of victimization than men and younger adults, and it is unclear whether these differences influence the health-perception relationship. We used the Midlife in the United States study to test whether baseline neighborhood safety perceptions would be associated with chronic health conditions 10 years later, and whether this relation differs by gender, age, and individual and neighborhood SES. Chronic health conditions included items such as respiratory problems, cancer, autoimmune disorders, digestive problems, pain, infections, cardiovascular conditions, sleep problems, and depression and anxiety. Results indicated that people who perceived lower neighborhood safety had more health problems 10 years later than those perceiving more neighborhood safety. These findings persisted after adjusting for baseline health, neighborhood income, individual income, and individual sociodemographics. This relation was partially mediated by smoking. Results did not differ by gender, age, or individual SES. Our results indicate a longitudinal relation between feeling unsafe in one's neighborhood and later health problems among men and women representing a wide age and income range. Moreover, our findings support a behavioral pathway through which neighborhood safety perceptions may be linked to health.

Neighborhood features and physiological risk: An examination of allostatic load.

Poor neighborhoods may represent a situation of chronic stress, and may therefore be associated with health-related correlates of stress. We examined whether lower neighborhood income would relate to higher allostatic load, or physiological well-being, through psychological, affective, and behavioral pathways. Using data from the Biomarker Project of the Midlife in the United States (MIDUS) study and the 2000 Census, we demonstrated that people living in lower income neighborhoods have higher allostatic load net of individual income. Moreover, findings indicate that this relation is partially accounted for by anxious arousal symptoms, fast food consumption, smoking, and exercise habits.

Neighborhood cohesion and daily well-being: results from a diary study.

Neighborly cohesiveness has documented benefits for health. Furthermore, high perceived neighborhood cohesion offsets the adverse health effects of neighborhood socioeconomic adversity. One potential way neighborhood cohesion influences health is through daily stress processes. The current study uses participants (n = 2022, age 30-84 years) from The Midlife in the United States II and the National Study of Daily Experiences II, collected between 2004 and 2006, to examine this hypothesis using a within-person, daily diary design. We predicted that people who perceive high neighborhood cohesion are exposed to fewer daily stressors, such as interpersonal arguments, lower daily physical symptoms and negative affect, and higher daily positive affect. We also hypothesized that perceptions of neighborhood cohesion buffer decline in affective and physical well-being on days when daily stressors do occur. Results indicate that higher perceived neighborhood cohesion predicts fewer self-reported daily stressors, higher positive affect, lower negative affect, and fewer physical health symptoms. High perceived neighborhood cohesion also buffers the effects of daily stressors on negative affect, even after adjusting for other sources of social support. Results from the present study suggest interventions focusing on neighborhood cohesion may result in improved well-being and may minimize the adverse effect of daily stressors.