The Relationship of Neighborhood Disadvantage, Biological Aging, and Psychosocial Risk and Resilience Factors in Heart Failure Incidence Among Black Persons: A Moderated Mediation Analysis

Author:

Bey Ganga S1,Pike James R2ORCID,Zannas Anthony S3,Xiao Qian4ORCID,Yu Bing5,Shah Amil M6,Palta Priya7

Affiliation:

1. Department of Epidemiology, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina , USA

2. Bloomberg School of Public Health, Johns Hopkins University , Baltimore, Maryland , USA

3. Department of Psychiatry and Neuroscience, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina , USA

4. University of Texas Health Sciences Center at Houston , Houston, Texas , USA

5. School of Public Health, University of Texas Health Sciences Center at Houston , Houston, Texas , USA

6. Department of Medicine, Harvard Medical School , Boston, Massachusetts , USA

7. Department of Neurology, University of North Carolina at Chapel Hill School of Medicine Chapel Hill, North Carolina , USA

Abstract

Abstract Objectives Deprived living environments contribute to greater heart failure (HF) risk among non-Hispanic Black persons, who disproportionately occupy disadvantaged neighborhoods. The mechanisms for these effects are not fully explicated, partially attributable to an insufficient understanding of the individual factors that contribute additional risk or resilience to the impact of neighborhood disadvantage on health. The objective of this study was, therefore, to clarify the complex pathways over which such exposures act to facilitate more targeted, effective interventions. Given the evidence for a mediating role of biological age and a moderating role of individual psychosocial characteristics in the neighborhood disadvantage–HF link, we tested a moderated mediation mechanism. Methods Using multilevel causal moderated mediation models, we prospectively examined whether the association of neighborhood disadvantage with incident HF mediated through accelerated biological aging, captured by the GrimAge epigenetic clock, is moderated by hypothesized psychosocial risk (negative affect) and resilience (optimism) factors. Results Among a sample of 1,448 Black participants in the shared Jackson Heart Study–Atherosclerosis Risk in Communities cohort (mean age 64.3 years), 334 adjudicated incident hospitalized HF events occurred over a median follow-up of 18 years. In models adjusted for age and sex, the indirect (GrimAge-mediated) effect of neighborhood disadvantage was moderated by psychosocial risk such that for every standard deviation increase in negative affect the hazards of HF was 1.18 (95% confidence interval = 1.05, 1.36). No moderated mediation effect was detected for optimism. Discussion Findings support the necessity for multilevel interventions simultaneously addressing neighborhood and individual psychosocial risk in the reduction of HF among Black persons.

Funder

National Heart, Lung, and Blood Institute

National Institutes of Health

U.S. Department of Health and Human Services

National Institute on Minority Health and Health Disparities

National Institute on Aging

Publisher

Oxford University Press (OUP)

Subject

Geriatrics and Gerontology,Gerontology,Clinical Psychology,Social Psychology

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3. Distinct moderating pathways for psychosocial risk and resilience in the association of neighborhood disadvantage with incident heart failure among Black ­persons;Bey,2023

4. Biological age mediates the effects of perceived neighborhood problems on heart failure risk among Black persons;Bey,2022

5. The Identity Vitality-Pathology model: A novel theoretical framework proposing “identity state” as a modulator of the pathways from structural to health inequity;Bey,2022

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