Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Neighborhood Environment Characteristics and Control of Hypertension and Diabetes in a Primary Care Patient Sample



Hypertension control and diabetes control are important for reducing cardiovascular disease burden. A growing body of research suggests an association between neighborhood environment and hypertension or diabetes control among patients engaged in clinical care.


To investigate whether neighborhood conditions (i.e., healthy food availability, socioeconomic status (SES), and crime) were associated with hypertension and diabetes control.


Cross-sectional analyses using electronic medical record (EMR) data, U.S. Census data, and secondary data characterizing neighborhood food environments. Multivariate logistic regression analyses adjusted for potential confounders. Analyses were conducted in 2017.


Five thousand nine hundred seventy adults receiving primary care at three Baltimore City clinics in 2010–2011.

Main Measures

Census tract–level neighborhood healthy food availability, neighborhood SES, and neighborhood crime. Hypertension control defined as systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg. Diabetes control defined as HgbA1c < 7.

Key Results

Among patients with hypertension, neighborhood conditions were not associated with lower odds of blood pressure control after accounting for patient and physician characteristics. However, among patients with diabetes, in fully adjusted models accounting for patient and physician characteristics, we found that patients residing in neighborhoods with low and moderate SES had reduced odds of diabetes control (OR = 0.74 (95% CI = 0.57–0.97) and OR = 0.75 (95% CI = 0.57–0.98), respectively) compared to those living in high-SES neighborhoods.


Neighborhood disadvantage may contribute to poor diabetes control among patients in clinical care. Community-based chronic disease care management strategies to improve diabetes control may be optimally effective if they also address neighborhood SES among patients engaged in care.

This is a preview of subscription content, log in to check access.

Fig. 1


  1. 1.

    Ettehad D, Emdin CA, Kiran A, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016;387(10022):957–967.

  2. 2.

    Rapsomaniki E, Timmis A, George J, et al. Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1.25 million people. Lancet. 2014;383(9932):1899–1911.

  3. 3.

    Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation. 2017;135(10):e146–e603.

  4. 4.

    Carr LJ, Bartee RT, Dorozynski C, Broomfield JF, Smith ML, Smith DT. Internet-delivered behavior change program increases physical activity and improves cardiometabolic disease risk factors in sedentary adults: results of a randomized controlled trial. Prev Med. 2008;46(5):431–438.

  5. 5.

    Selvin E, Parrinello CM, Sacks DB, Coresh J. Trends in prevalence and control of diabetes in the United States, 1988-1994 and 1999-2010. Ann Intern Med. 2014;160(8):517–525.

  6. 6.

    Benoit SR, Fleming R, Philis-Tsimikas A, Ji M. Predictors of glycemic control among patients with Type 2 diabetes: a longitudinal study. BMC Public Health. 2005;5:36.

  7. 7.

    Wang X, Auchincloss AH, Barber S, et al. Neighborhood social environment as risk factors to health behavior among African Americans: The Jackson Heart Study. Health Place. 2017;45:199–207.

  8. 8.

    Yoon SS, Carroll MD, Fryar CD. Hypertension Prevalence and Control Among Adults: United States, 2011-2014. NCHS Data Brief. 2015(220):1–8.

  9. 9.

    Debnath S, Thameem F, Alves T, et al. Diabetic nephropathy among Mexican Americans. Clin Nephrol. 2012;77(4):332–344.

  10. 10.

    Tarver-Carr ME, Powe NR, Eberhardt MS, et al. Excess risk of chronic kidney disease among African-American versus white subjects in the United States: a population-based study of potential explanatory factors. J Am Soc Nephrol. 2002;13(9):2363–2370.

  11. 11.

    Diez Roux AV, Merkin SS, Arnett D, et al. Neighborhood of residence and incidence of coronary heart disease. N Engl J Med. 2001;345(2):99–106.

  12. 12.

    Leal C, Chaix B. The influence of geographic life environments on cardiometabolic risk factors: a systematic review, a methodological assessment and a research agenda. Obes Rev. 2011;12(3):217–230.

  13. 13.

    Bilal U, Auchincloss AH, Diez-Roux AV. Neighborhood Environments and Diabetes Risk and Control. Curr Diab Rep. 2018;18(9):62.

  14. 14.

    Buczynski AB, Freishtat H, Buzogany S.Mapping Baltimore City’s Food Environment: 2015 Report. Johns Hopkins Center for a Livable Future;2015.

  15. 15.

    Franco M, Diez-Roux AV, Nettleton JA, et al. Availability of healthy foods and dietary patterns: the Multi-Ethnic Study of Atherosclerosis. Am J Clin Nutr. 2009;89(3):897–904.

  16. 16.

    Gucciardi E, Vahabi M, Norris N, Del Monte JP, Farnum C. The Intersection between Food Insecurity and Diabetes: A Review. Curr Nutr Rep. 2014;3(4):324–332.

  17. 17.

    Kelli HM, Kim JH, Samman Tahhan A, et al. Living in Food Deserts and Adverse Cardiovascular Outcomes in Patients With Cardiovascular Disease. J Am Heart Assoc. 2019;8(4):e010694.

  18. 18.

    Cooper LA, Marsteller JA, Noronha GJ, et al. A multi-level system quality improvement intervention to reduce racial disparities in hypertension care and control: study protocol. Implement Sci. 2013;8:60.

  19. 19.

    Diez-Roux AV, Kiefe CI, Jacobs DR, Jr., et al. Area characteristics and individual-level socioeconomic position indicators in three population-based epidemiologic studies. Ann Epidemiol. 2001;11(6):395–405.

  20. 20.

    Diez Roux AV. Investigating neighborhood and area effects on health. Am J Public Health. 2001;91(11):1783–1789.

  21. 21.

    Jennings JM, Milam AJ, Greiner A, Furr-Holden CD, Curriero FC, Thornton RJ. Neighborhood alcohol outlets and the association with violent crime in one mid-Atlantic City: the implications for zoning policy. J Urban Health. 2014;91(1):62–71.

  22. 22.

    Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42(6):1206–1252.

  23. 23.

    Standards of Medical Care in Diabetes-2017: Summary of Revisions. Diabetes Care. 2017;40(Suppl 1):S4–S5.

  24. 24.

    Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–383.

  25. 25.

    Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008. JAMA. 2010;303(20):2043–2050.

  26. 26.

    Tabaei BP, Rundle AG, Wu WY, et al. Associations of Residential Socioeconomic, Food, and Built Environments With Glycemic Control in Persons With Diabetes in New York City From 2007-2013. Am J Epidemiol. 2018;187(4):736–745.

  27. 27.

    de Vries McClintock HF, Wiebe DJ, O’Donnell AJ, Morales KH, Small DS, Bogner HR. Neighborhood social environment and patterns of adherence to oral hypoglycemic agents among patients with type 2 diabetes mellitus. Fam Community Health. 2015;38(2):169–179.

  28. 28.

    Sims M, Diez Roux AV, Boykin S, et al. The socioeconomic gradient of diabetes prevalence, awareness, treatment, and control among African Americans in the Jackson Heart Study. Ann Epidemiol. 2011;21(12):892–898.

  29. 29.

    Weiner SJ, Schwartz A, Weaver F, et al. Contextual errors and failures in individualizing patient care: a multicenter study. Ann Intern Med. 2010;153(2):69–75.

  30. 30.

    Morland K, Diez Roux AV, Wing S. Supermarkets, other food stores, and obesity: the atherosclerosis risk in communities study. Am J Prev Med. 2006;30(4):333–339.

  31. 31.

    Lovasi GS, Hutson MA, Guerra M, Neckerman KM. Built environments and obesity in disadvantaged populations. Epidemiol Rev. 2009;31:7–20.

  32. 32.

    Delamater A. Improving Patient Adherence. Clin Diabetes. 2006;24(2):71–77.

  33. 33.

    Krieger N. Embodiment: a conceptual glossary for epidemiology. J Epidemiol Community Health. 2005;59(5):350–355.

  34. 34.

    Berube A, McDearman B. Good fortune, dire poverty, and inequality in Baltimore: An American story. In. Vol 2017. Brookings 2015.

  35. 35.

    Pietila A.Not in My Neighborhood: How Bigotry Shaped a Great American City.: Rowman & Littlefield; 2012.

  36. 36.

    White K, Haas JS, Williams DR. Elucidating the role of place in health care disparities: the example of racial/ethnic residential segregation. Health Serv Res. 2012;47(3 Pt 2):1278–1299.

  37. 37.

    Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;74(10):1376–1414.

  38. 38.

    National Academies of Sciences, Engineering, and Medicine. Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation’s Health. Washington: The National Academies Press 2019.

  39. 39.

    Hibbard JH, Greene J. What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs. Health Aff (Millwood). 2013;32(2):207–214.

Download references


We would like to express our thanks to Kit Carson for her technical assistance related to the data acquisition.


This work was supported by grants from the National Heart, Lung and Blood Institute (P50HL0105187 [LAC, YJH], K24HL083113 [LAC], T32HL007180 [MM], and K23HL12150 [RLJT]). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Correspondence to Rachel L. J. Thornton MD, PhD.

Ethics declarations

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Prior Presentations

An abstract of this article was presented at the AHA/EPI|Lifestyle Conference in New Orleans, LA, on March 20–23, 2018.

Electronic supplementary material


(DOCX 46.3 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

McDoom, M.M., Cooper, L.A., Hsu, Y. et al. Neighborhood Environment Characteristics and Control of Hypertension and Diabetes in a Primary Care Patient Sample. J GEN INTERN MED (2020).

Download citation