Neighborhoods and cumulative biological risk profiles by race/ethnicity in a national sample of U.S. adults: NHANES III

Ann Epidemiol. 2009 Mar;19(3):194-201. doi: 10.1016/j.annepidem.2008.12.006.


Purpose: To examine race/ethnic-specific patterns of association between neighborhood socioeconomic status (NSES) and a cumulative biological risk index in a nationally representative population.

Methods: The study sample included 13,199 white, black, and Mexican-American men and women, ages 20 and older, who attended the National Health and Examination Survey examination (1988-1994). Neighborhoods were defined as census tracts and linked to U.S. Census measures from 1990 and 2000, interpolated to the survey year; the NSES score included measures of income, education, poverty, and unemployment and was categorized into quintiles, with the highest indicating greater NSES. A summary biological risk score, allostatic load (AL; range 0-9), was created from 9 biological indicators of elevated risk: serum levels of C-reactive protein, albumin, glycated hemoglobin, total and high-density lipoprotein cholesterol, waist-to-hip ratio, systolic and diastolic blood pressure, and resting heart rate. Regression models stratified by race/ethnicity examined AL as a continuous and dichotomous (>or=3 vs. <3) outcome.

Results: We found strong inverse associations between NSES and AL for black subjects, after adjusting for age, sex, U.S. birth, urban location, and individual SES. These associations were weaker and less consistent for Mexican Americans and whites.

Conclusions: Our results indicate that living in low NSES neighborhoods is most strongly associated with greater cumulative biological risk profiles in the black U.S. population.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Biomarkers / blood
  • Blood Pressure / physiology
  • Female
  • Health Status Disparities*
  • Humans
  • Male
  • Nutrition Surveys
  • Physical Examination
  • Regression Analysis
  • Residence Characteristics*
  • Risk Factors
  • Social Class*
  • United States
  • Young Adult


  • Biomarkers