Introduction
Despite the growing recognition of the importance of neighborhood conditions for cardiometabolic
health, causal relationships have been difficult to establish owing to a reliance
on cross-sectional designs and selection bias. This is the first natural experiment
to examine the impact of neighborhood revitalization on cardiometabolic outcomes in
residents from 2 predominantly African American neighborhoods, one of which has experienced
significant revitalization (intervention), whereas the other has not (comparison).
Methods
The sample included 532 adults (95% African American, 80% female, mean age=58.9 years)
from 2 sociodemographically similar, low-income neighborhoods in Pittsburgh, PA, with
preintervention and postintervention measures (2016 and 2018) of BMI, diastolic and
systolic blood pressure, HbA1c, and high-density lipoprotein cholesterol and covariates.
Data were collected in 2016 and 2018 and analyzed in 2020.
Results
Difference-in-difference analyses showed significant improvement in high-density lipoprotein
cholesterol in intervention residents relative to that in the comparison neighborhood
(β=3.88, 95% CI=0.47, 7.29). There was also a significant difference-in-difference
estimate in diastolic blood pressure (β=3.00, 95% CI=0.57, 5.43), with residents of
the intervention neighborhood showing a greater increase in diastolic blood pressure
than those in the comparison neighborhood. No statistically significant differences
were found for other outcomes.
Conclusions
Investing in disadvantaged neighborhoods has been suggested as a strategy to reduce
health disparities. Using a natural experiment, findings suggest that improving neighborhood
conditions may have a mixed impact on certain aspects of cardiometabolic health. Findings
underscore the importance of examining the upstream causes of health disparities using
rigorous designs and longer follow-up periods that provide more powerful tests of
causality.
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Article Info
Publication History
Published online: July 02, 2021
Identification
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© 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
