Abstract 13: Racial Differences in the Impact of Multiple Social Vulnerabilities to Health Disparities and Hypertension and Death in the Reasons for Geographic and Racial Differences in Stroke (regards) Study

Background:Individual social vulnerabilities to health disparities increase the risk of developing hypertension and lower life expectancy, but their cumulative effect on these outcomes is unknown.Methods:Using the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, we included participants aged 45 years or older without hypertension at baseline (i.e., systolic/diastolic blood pressure <130/80 mm Hg and no antihypertensive medication use). The exposure was count of vulnerabilities at baseline which were defined across economic, education, health and health care, neighborhood and built environment, and social and community context domains. The primary outcome took on three levels: 1) alive at follow-up without hypertension (reference group), 2) alive at follow-up with hypertension, or 3) deceased prior to follow-up 10-year risk of hypertension or death. Multinomial logistic regression was used to determine associations of the count of vulnerabilities with hypertension and survival status at the second in-home visit, expressed as adjusted relative risk ratios (aRRR). Analyses were stratified by race.Results:Among 5425 participants (mean±SD age of 63±10 years, 24% black, and 54% female), 1785 (33%) participants developed hypertension and 1135 (21%) participants died. A greater proportion of black participants developed hypertension and died than did white participants (hypertension, 38% vs 31%; death, 25% vs 20%). The associations between vulnerability count and both hypertension and death were stronger in white participants than black participants (p-value for vulnerability count*race interaction: hypertension = 0.042, death =0.021; Figure 1).Conclusions:The relative effect of multiple social vulnerabilities on hypertension development may be stronger in white adults than black adults. Nonetheless, black adults experience the highest absolute rates of hypertension in all subpopulations.