What question did this study set out to answer?

This study investigates the link between neighborhood-level social determinants of health and blood pressure control.

May 13, 2026

Neighborhood Level Social Determinants of Health and Loss of Blood Pressure Control

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Normotensive blood pressure (n=94276). Intervention: Lowest quartile Healthy Places Index (HPI) score vs. Highest quartile HPI score. Primary outcome: Development of high BP (systolic BP ≥ 130 or diastolic BP ≥ 80 mmHg) (PR 1.07, 95% CI 1.05-1.10).

JLJonathan N. LeCedars-Sinai Medical Center THTzu Yu HuangCedars-Sinai Smidt Heart Institute PBPatrick BottingCedars-Sinai Smidt Heart Institute

Key Result

Living in a neighborhood with the lowest versus highest quartile Healthy Places Index score was associated with an increased risk of developing high blood pressure (PR 1.07; 95% CI 1.05-1.10).

Key Points

This study investigates the link between neighborhood-level social determinants of health and blood pressure control.
Single-center retrospective cohort study at Cedars-Sinai Medical Center from 2018-2023.
Linked adults with ≥2 outpatient visits/year to the Healthy Places Index.
Assessed normotensive patients developing high blood pressure in the following year.
Among 94,276 adults, 41.1% developed high blood pressure.
Living in a neighborhood with the lowest HPI score was linked to a higher risk of developing high blood pressure (PR 1.07, 95% CI 1.05-1.10).
Economic (PR 1.04, 95% CI 1.00-1.07) and educational attainment (PR 1.05, 95% CI 1.02-1.08) were significant contributing factors.

Study Design

Type

Cohort (n=94,276)

Multicenter

Structured PICO

Does living in a neighborhood with lower social determinants of health increase the risk of developing high blood pressure in adults with previously controlled blood pressure?

Population

94,276 adults with normotensive BP (<130/80 mmHg) and ≥2 outpatient visits/year in at least 2 consecutive years, median age 56.4 ± 18.8 years, 37.2% male, at a single center (Cedars-Sinai Medical Center).

Intervention

Living in a neighborhood with a Healthy Places Index (HPI) score in the lowest quartile (lower social determinants of health status)

Comparator

Living in a neighborhood with a HPI score in the highest quartile

Outcome

Development of high BP (systolic BP ≥ 130 or diastolic BP ≥ 80 mmHg) in the following yearsurrogate

Lower neighborhood-level social determinants of health, particularly economic and educational attainment, are associated with an increased risk of losing blood pressure control.

Main Result

Effect estimate: PR 1.07 (95% CI 1.05-1.10)

Abstract

BACKGROUND: A deeper understanding of the association between blood pressure (BP) control and neighborhood-level social determinants of health (SDOH) may help elucidate nonclinical factors that contribute to hypertension disparities. We sought to evaluate patterns of BP elevations by neighborhood-level SDOH domains. METHODS: In this single-center retrospective cohort study at Cedars-Sinai Medical Center, adults with ≥2 outpatient visits/year in at least 2 consecutive years (each consecutive 2-year period forms a dyad) from 2018-2023 were linked to the Healthy Places Index (HPI), a measure of neighborhood SDOH. Among patients with normotensive BP (BP 94,000 adults starting with BP < 130/80 mmHg, an increase in BP above this threshold in the following year was associated with neighborhood-level SDOH status, particularly variations in economic and educational attainment.

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Cite This Study

Le et al. (Fri,) conducted a cohort in Normotensive blood pressure (n=94,276). Lowest quartile Healthy Places Index (HPI) score vs. Highest quartile HPI score was evaluated on Development of high BP (systolic BP ≥ 130 or diastolic BP ≥ 80 mmHg) (PR 1.07, 95% CI 1.05-1.10). Living in a neighborhood with the lowest versus highest quartile Healthy Places Index score was associated with an increased risk of developing high blood pressure (PR 1.07; 95% CI 1.05-1.10).

synapsesocial.com/papers/6a04158679e20c90b44453ef https://doi.org/https://doi.org/10.1093/ajh/hpag046

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