Association Between Acute Exposure to Crime and Individual Systolic Blood Pressure

Published:September 15, 2021DOI:


      Hypertension is associated with adverse cardiovascular outcomes and is geographically concentrated in urban underserved neighborhoods. This study examines the temporal–spatial association between individual exposure to violent crime and blood pressure.


      A retrospective observational cohort study analyzed 39,211 patients with 227,595 blood pressure measurements from 2014 to 2016 at 3 outpatient clinics at an academic medical center in Chicago. Patients were included in the study if they had documentation of blood pressure in the medical record and resided in census tracts with >1,000 observations. Geocoded violent crime events were obtained from the Chicago Police Department. Individual-level exposure was defined on the basis of spatial and temporal buffers around each patient's home. Spatial buffers included 100-, 250-, 500-, and 1,000-meter disc radii, and temporal buffers included 7, 30, and 60 days preceding each outpatient appointment. Systolic blood pressure measurements (mmHg) were abstracted from the electronic health record. Analysis was performed in 2019–2020.


      For each violent crime event within 100 meters from home, systolic blood pressure increased by 0.14 mmHg within 7 days of exposure compared with 0.08 mmHg at 30 days of exposure. In analyses stratified by neighborhood cluster, systolic blood pressure increased by 0.37 mmHg among patients in the suburban affluent cluster relative to that among those in an extreme poverty cluster for the same spatial and temporal buffer.


      Exposure to a violent crime event was associated with increased blood pressure, with gradient effects by both distance and time from exposure.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Grotto I
        • Huerta M
        • Sharabi Y
        Hypertension and socioeconomic status.
        Curr Opin Cardiol. 2008; 23: 335-339
        • Diez Roux AV
        • Mujahid MS
        • Hirsch JA
        • Moore K
        • Moore LV
        The impact of neighborhoods on CV risk.
        Glob Heart. 2016; 11: 353-363
        • Coulon SM
        • Wilson DK
        • Alia KA
        • Van Horn ML
        Multilevel associations of neighborhood poverty, crime, and satisfaction with blood pressure in African-American adults.
        Am J Hypertens. 2016; 29: 90-95
        • Mujahid MS
        • Diez Roux AV
        • Morenoff JD
        • et al.
        Neighborhood characteristics and hypertension.
        Epidemiology. 2008; 19: 590-598
        • Billimek J
        • Sorkin DH
        Self-reported neighborhood safety and nonadherence to treatment regimens among patients with type 2 diabetes.
        J Gen Intern Med. 2012; 27: 292-296
        • Kaiser P
        • Diez Roux AV
        • Mujahid M
        • et al.
        Neighborhood environments and incident hypertension in the Multi-Ethnic Study of Atherosclerosis.
        Am J Epidemiol. 2016; 183: 988-997
        • Mayne SL
        • Moore KA
        • Powell-Wiley TM
        • Evenson KR
        • Block R
        • Kershaw KN
        Longitudinal associations of neighborhood crime and perceived safety with blood pressure: the Multi-Ethnic Study of Atherosclerosis (MESA).
        Am J Hypertens. 2018; 31: 1024-1032
        • Suglia SF
        • Sapra KJ
        • Koenen KC
        Violence and cardiovascular health: a systematic review.
        Am J Prev Med. 2015; 48: 205-212
        • Tung EL
        • Wroblewski KE
        • Boyd K
        • Makelarski JA
        • Peek ME
        • Lindau ST
        Police-recorded crime and disparities in obesity and blood pressure status in Chicago.
        J Am Heart Assoc. 2018; 7e008030
        • Tung EL
        • Chua RFM
        • Besser SA
        • et al.
        Association of rising violent crime with blood pressure and cardiovascular risk: longitudinal evidence from Chicago, 2014-2016.
        Am J Hypertens. 2019; 32: 1192-1198
      1. Chicago Police Department. Chicago Data Portal. Updated June 30, 2018. Accessed July 1, 2018.

        • Chida Y
        • Steptoe A
        Greater cardiovascular responses to laboratory mental stress are associated with poor subsequent cardiovascular risk status: a meta-analysis of prospective evidence.
        Hypertension. 2010; 55: 1026-1032
        • Kolak M
        • Bhatt J
        • Park YH
        • Padrón NA
        • Molefe A
        Quantification of neighborhood-level social determinants of health in the continental United States.
        JAMA Netw Open. 2020; 3e1919928
        • McEwen BS
        Stress, adaptation, and disease allostasis and allostatic load.
        Ann N Y Acad Sci. 1998; 840: 33-44
        • McEwen B
        • Lasley EN
        Allostatic load: when protection gives way to damage.
        Adv Mind Body Med. 2003; 19: 28-33
        • Wilson DK
        • Kliewer W
        • Sica DA
        The relationship between exposure to violence and blood pressure mechanisms.
        Curr Hypertens Rep. 2004; 6: 321-326
        • Mobley LR
        • Root ED
        • Finkelstein EA
        • Khavjou O
        • Farris RP
        • Will JC
        Environment, obesity, and cardiovascular disease risk in low-income women.
        Am J Prev Med. 2006; 30: 327-332
        • Clark R
        • Benkert RA
        • Flack JM
        Violence exposure and optimism predict task-induced changes in blood pressure and pulse rate in a normotensive sample of inner-city black youth.
        Psychosom Med. 2006; 68: 73-79
        • Browning CR
        • Cagney KA
        • Iveniuk J
        Neighborhood stressors and cardiovascular health: crime and C-reactive protein in Dallas, USA.
        Soc Sci Med. 2012; 75: 1271-1279
        • Smalls BL
        • Gregory CM
        • Zoller JS
        • Egede LE
        Assessing the relationship between neighborhood factors and diabetes related health outcomes and self-care behaviors.
        BMC Health Serv Res. 2015; 15: 445
        • O'Donnell M
        • Mente A
        • Yusuf S
        Sodium intake and cardiovascular health.
        Circ Res. 2015; 116: 1046-1057