Longitudinal associations of neighborhood-level racial residential segregation with cardiometabolic health

Strong and persistent racial disparities exist for several cardiometabolic health outcomes including obesity, diabetes, and hypertension. Although a growing number of studies have investigated the contributions of the residential environment, few have examined the possible role of neighborhood-level racial residential segregation and these studies have largely been cross-sectional. Furthermore, the bulk of the existing literature on neighborhood-level segregation and health use racial composition as a proxy for neighborhood segregation. This measure is limited in that it is independent of the residential patterning of the larger city. It is also an aspatial measure, meaning it focuses solely on the racial composition of a specific neighborhood and does not account for the composition of adjacent neighborhoods. Thus, the purpose of this ancillary study is to use geocoded information on CARDIA participants to assess longitudinal associations of a spatial, contextual measure of neighborhood-level racial residential segregation with several cardiometabolic health indicators. Specifically, this study aims to 1) examine longitudinal associations of neighborhood-level residential segregation with body mass index, waist circumference, diabetes, blood pressure, diet, and physical activity; 2) test whether these associations are mediated by chronic stress and measures of the built environment; and 3) assess whether these associations are modified by gender, race, and neighborhood poverty. Marginal structural modeling will be used to account for time-varying confounding in order to more closely approximate the causal effect of neighborhood-level residential segregation on several cardiometabolic health outcomes. A better understanding of how the process of segregation influences health can help guide the development of more effective interventions to reduce disparities in cardiometabolic health.