The Place of Race in Hypertension: How Family Background and Neighborhood Conditions in Childhood Impact Later-life Health

This paper investigates the role of family background and neighborhood conditions over the life course, particularly during childhood, in influencing health later in life, with a focus on the case of hypertension. Most of the black-white difference in life expectancy stem from racial differences in mortality rates prior to age 65. Thus, understanding sources of racial health disparities requires the investigation of exposures to socioeconomic conditions and risk factors earlier in the life cycle. Blacks' higher prevalence of cardiovascular disease-related risk factors account for more than half of the racial disparity in life expectancy (Barghaus, Cutler, Fryer, and Glaeser, 2007), with hypertension the leading culprit. For a US cohort born between 1951 and 1970, I produce nationally representative estimates of the onset of hypertension through mid-life by race/ethnicity, childhood socioeconomic status, and childhood neighborhood poverty. I provide evidence on the consequences of childhood neighborhood poverty on the risks of hypertension; this is the first such study of the full US population. I use nationally representative longitudinal data from the US spanning nearly four decades to estimate hazard models of onset of hypertension. The data set, the Panel Study of Income Dynamics (PSID), has the additional unique feature of allowing analyses of siblings and child neighbors throughout much of their life course. I use the resemblance between neighboring children's subsequent likelihood of hypertension in adulthood in comparison to the similarity between siblings to bound the proportion of inequality in this health condition that can be attributed to disparities in neighborhood and family background. I estimate four-level hierarchical random effects hazard models of the onset of hypertension, which provide a better understanding of the relative importance of family and neighborhood backgrounds. The results demonstrate that both childhood neighborhood conditions and family background influence the disease process and risk of hypertension later in life. I find childhood neighborhood poverty and its attendant stressors play an influential role in shaping risks of onset of hypertension in middle-age. Other notable neighborhood factors that were shown to influence risks of onset of hypertension in adulthood include childhood neighborhood crime exposure and county per-pupil school expenditures. Notable family background factors include birth weight, parental health status, and parental socioeconomic status. These effects appear linked in part to low intergenerational economic mobility, particularly among blacks. The results indicate that racial differences in these early life neighborhood conditions and family background characteristics play a significant role in explaining racial …