Women who live in neighborhoods where many families are headed by women are more likely to die from heart disease than women who live in neighborhoods with a greater proportion of two-parent families, new research has shown.
This, the researchers say, may account in part for why African American women die more often from heart disease than do white women even though they experience heart disease at similar rates.
Writing in the June issue of the Journal of Health and Social Behavior, Felicia B. LeClere, PhD, now at the University of Notre Dame, and her colleagues report their conclusions from analysis of five years of data from the National Health Interview Survey, an annual health survey conducted by the National Center for Health Statistics (NCHS).
LeClere and her colleagues matched the survey respondents to death records from 1985 through 1990 and to 1990 census information on the almost 6,000 neighborhoods where they lived. Of 199,221 women originally interviewed in the survey, 2,014 died of heart disease in the follow-up periods. Additional measures used in the study included family income, education, age, marital status, body mass index, and existing chronic conditions.
The researchers concluded that neighborhood poverty - associated with families headed by women - appears to be the primary risk factor for death from heart disease for women who die young.
Among those who die of heart disease later in life, they report, the social and physical stress of serving multi-generation obligations appears to be a more important factor. In addition, the large race difference in heart disease mortality is explained in part by the fact that older African American women are more likely to live in neighborhoods where the majority of families are headed by women. Consequently, their health is more likely to be compromised by this network of family and social obligations.
"Public health policy has largely focused on such individual risk factors for heart disease as obesity and smoking, or access to health care," Dr. LeClere said. "It is clear from this study and others like it that the progression of chronic disease lies not only with individual behavior but also with the quality of the larger community."
Previous health research, she noted, often ignored the risk that local economic and social environment may pose to the health of its residents beyond those associated with external causes of death, such as homicide. African Americans are more likely to be exposed to neighborhood environments that have negative impacts on their health and, therefore, these environmental factors are critical to understanding their disavantaged health status.
The research was conducted while LeClere was a health statistician with the NCHS at the Centers for Disease Control and Prevention. Other researchers were Richard G. Rogers, associate professor, and Kimberley Peters, an NCHS demographic statistician and PhD candidate, both at the University of Colorado, Boulder.
The Health Research and Services Administration providing funding for the geocoding of the National Health Interview Survey.
Journal
Journal of Health and Social Behavior