Examining the Relationship between Environmental Stressors and Hypertension Among Black/African Americans and Hispanic/Latinx Residents Living in Bronx County New York

Background/Purpose: The prevalence of hypertension among racial and ethnic minorities in the United States—primarily those who identify as Black/African American—is the highest in the world.This study supports the urgency for the medical field to center issues of socio-economic, racialized and gendered disparities into its models and training.

Allostatic load is the accumulation and long-term effects of physiological wear and tear that is a result of chronic strain and stress on the body. These stressors begin early childhood and accumulate throughout the life course. Numerous factors influence the accrual of allostatic load, such as the social and physical environment. Individuals with low socioeconomic status living in poor neighborhoods are at greater risks of experiencing daily environmental stressors, such as community violence and the lack of economic opportunities. Based on the historical legacy of white supremacy of this country, we contend it is institutional racism that must recognized as contributor to high allostatic load and precursor to ongoing health disparities.

Methods: Community data were obtained from the cross-sectional population-based New York City Department of Health and Mental Hygiene’s 2015-2016 Community Health Survey. These data were collected through computer-assisted telephone interviews with New York City residents age 18 and older. Allostatic load (chronic life stressors) was operationalized using rent burden, poverty, and neighborhood demographics.

Results: In New York City, 1,820,000 (28.1%) of residents reported a diagnosis of hypertension between 2015-2016. The prevalence of hypertension in Bronx County was highest among Hispanic/Latinx at 39.5% (553,000) and Black/African American at 39% (319,000). Seventy-six percent of Black/African American, and 68% of Hispanic/Latinx reported being prescribed hypertension medications at some point in their diagnosis.

Individuals diagnosed with hypertension will spend an average of $740 - $1,200 or more per year. The average hypertension resident living in Bronx County is currently living below the FPL and spends more than 30% of their monthly income on rent.

Conclusions and Implications:

Allostatic load offers a bridge in terminology for social workers to more effectively advocate for the inclusion of systemic racism as a priority to be addressed in the health care field. These data show that Black/African Americans and Hispanic/Latinx Americans have the highest rate of hypertension and the lowest rate of hypertension control—coupled with the highest rate of poverty, high rent burden, and the lowest rate of employment among residents of all New York City’s five boroughs. These findings suggest that there may be a significant relationship between chronic life stressors and the rate of hypertension, one of the leading causes of mortality, among Black/African Americans and Hispanic/Latinx Americans living in Bronx County.