Neighborhood and Individual Determinants of Cardiometabolic Health: Obesity and Blood Pressure

Pescador Jimenez, Marcia Ixchel

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Year:: 2018
Contributor:: Pescador Jimenez, Marcia Ixchel (creator); Loucks, Eric B. (Advisor); Wellenius, Gregory A. (Reader); Subramanian, S.V. (Reader); Brown University. Department of Epidemiology (sponsor)
Genre:: theses
Subject:: Epidemiology; Neighborhoods; Hypertension; Multilevel models (Statistics); Longitudinal studies; Obesity--Prevention; Epidemiology--Social aspects; Cluster analysis
Extent:: 3, 105 p.
DOI: https://doi.org/10.26300/f94c-7536

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Abstract:: Abstract of "Neighborhood and Individual Determinants of Cardiometabolic Health: Obesity and Blood Pressure", by Marcia I. Pescador Jimenez, Ph.D., Brown University, May 2018. Despite significant declines in mortality in the U.S., cardiovascular disease (CVD) remains a considerable public health burden. In particular, hypertension and obesity are 2 major risk factors of CVD. A growing social epidemiology literature states that neighborhood context is associated with a range of adverse consequences on CVD. A life-course epidemiology literature has uncovered the effects of early life exposures on CVD. However, these areas of study have evolved separately. Incorporating both place and time for understanding causes of CVD is one of the key challenges for epidemiologic research. In the first two chapters of this project, we used multilevel models to evaluate the longitudinal association between social and physical context with blood pressure and obesity. To our knowledge, this study’s longitudinal design is the first to assess the association between objectively measured neighborhood characteristics from birth through adulthood, and CVD risk. On the third chapter, we focused on obesity. Currently, guidelines, randomized trials and epidemiologic studies tend to consider obesity as a homogeneous entity. Additionally, previous studies suggest that the association between neighborhood and obesity is not direct and that researchers must look into other individual determinants. Using cluster analysis and comprehensive population level data in the United States, we examined complex interaction of biological, behavioral, and social factors that intersect with obesity. To our knowledge, this is the first analysis of obesity patterns in adults in the U.S. that identifies subgroups among individuals categorized as obese. Results from the life-course analysis of cardio-metabolic health suggested that neighborhood exposures during early childhood were associated with a decrease of blood pressure in adulthood. In addition, the proportion of variability of blood pressure explained by neighborhood at the earliest years of life suggested intervention time-periods that may be more effective to reduce cardiometabolic risk. The individual heterogeneity of obesity found in chapter 3 provided a basis for future studies to evaluate whether different strategies may be needed in the clinical management of obesity. We conclude that distinctive groups of obese individuals and deprived neighborhoods might be at higher risk and should be prioritized for public health assistance.
Notes:: Thesis (Ph. D.)--Brown University, 2018

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Rights: In Copyright
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Pescador Jimenez, Marcia Ixchel, "Neighborhood and Individual Determinants of Cardiometabolic Health: Obesity and Blood Pressure" (2018). Epidemiology Theses and Dissertations. Brown Digital Repository. Brown University Library. https://doi.org/10.26300/f94c-7536

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Epidemiology Theses and Dissertations

Theses and Dissertations for the Epidemiology department.
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