Residential Segregation and Framingham 30-Year Cardiovascular Disease Risk Among Black and White Young Adults in the National Longitudinal Study of Adolescent to Adult Health

The lasting health and social effects of the US federal housing policies that created racial residential segregation have been substantial. We aim to evaluate the association between three dimensions of residential segregation (i.e., evenness, exposure, and concentration) and the Framingham 30-year cardiovascular (CVD) risk score. Using the Longitudinal Study of Adolescent to Adult Health, we examined the extent to which three features of Wave I residential segregation were associated with Wave IV Framingham 30-year CVD risk score using separate General Estimating Equation models that accounted for the complex clustered study design. We also examined differences in the associations by race (i.e., non-Hispanic Black and non-Hispanic White). For each exposure, we ran unadjusted covariate adjusted, and a covariate adjusted model containing an interaction between race and the segregation measure. We observed that none of the residential segregation measures were associated with 30-year CVD risk. However, we observed a statistically significant interaction between race and the Black vs. White Index of Concentration of Extremes, whereby segregation was associated with an 8% higher CVD risk among Black participants and a 3% lower CVD risk among White participants. This research suggests that Black young adults residing in communities that have a higher concentration of White residents is harmful to their cardiovascular health, while it is beneficial for White residents. These findings are consistent with the existing literature on harmful effects of structural racism on CVD outcomes and specific CVD risk factors.