Social Determinants of Health and Clinical Hypertension and Diabetes Prevalence on Chicago’s South Side

Keywords: segregation, recession, health inequality, structural racism
Session Type: Virtual Paper
Day: Friday
Session Start / End Time: 4/9/2021 01:30 PM (Pacific Time (US & Canada)) - 4/9/2021 02:45 PM (Pacific Time (US & Canada))
Room: Virtual 8

Abstract

Social determinants of health (SDOH) critically impact healthcare access and outcomes. However, few studies have examined spatial relationships between SDOH and disease prevalence at neighborhood scales. In this study, we merged data from a major Chicago hospital system with social data at the census tract level. We hypothesized that tracts with disadvantageous SDOH have greater prevalence of hypertension and diabetes than other nearby tracts. We calculated a clinical population prevalence for patients diagnosed with hypertension and diabetes for each census tract. We identified spatial clusters of disease from 2014 to 2018, and modeled prevalence rates for each disease as a function of SDOH, including poverty, minority status, food access, walkability, foreclosure risk, crime, and others. The sample consisted of 243,685 outpatient visits/encounters and 46,425 unique patients. Clinical population prevalence rates for patients with hypertension had a strong positive association with areas with high rates of poverty, minority, and disability status (Spatial Pseudo R2=0.72). Neighboring tracts with high disease rates are the strongest predictor of cardiovascular-related chronic disease by several orders of magnitude, more than the effects of age and race combined; this spatial signal may proxy residential segregation patterns. On Chicago’s South Side, segregated areas hit hardest by foreclosures, now largely composed of elder, minority homeowners, had high rates of hypertension and diabetes. Minority neighborhoods were targeted for predatory loans in the Great Recession, and faced higher probabilities of loan denials post-Recession. A more nuanced understanding of place can facilitate insight into the complexity of structural factors that impact health.