Abstract P359: Long-Term Exposure to Neighborhood Poverty Throughout Midlife and Subclinical Cardiovascular Disease Burden in Subsequent Years: The Study of Women's Health Across the Nation
Authors: Schiff Mary D , Barinas-Mitchell Emma , Brooks Maria , Mair Christina , Mendez Dara , Naimi Ashley , Reeves Alexis , Hedderson Monique , Janssen Imke , Fabio Anthony 
Published: March 2023

Purpose:
To examine whether longitudinal exposure to neighborhood poverty throughout midlife influences the degree of subclinical CVD (SCVD) burden experienced in early old age in a racially and ethnically-diverse cohort of women transitioning through menopause.

Methods:
We used longitudinal data on 1,212 women (aged 42-52 at baseline) from
The Study of Women’s Health Across the Nation
. Residential address histories were collected annually for eleven years across midlife (1996-2007). The following carotid ultrasound SCVD measures were collected during a subsequent follow-up visit (2009-2013): intima media thickness (CIMT), inter-adventitial diameter (IAD), and plaque presence. Values >75th percentile of each were considered high (CIMT > 0.79 mm; IAD > 7.21 mm; plaque index >=2) and were summed together to create our composite SCVD index (range: 0-3). We used longitudinal latent class analysis to identify distinct patterns of exposure to high neighborhood poverty among women across midlife, and used ordinal logistic regression models to determine if a woman’s neighborhood poverty class throughout midlife was associated with her future SCVD burden.

Results:
We identified five longitudinal neighborhood poverty classes across midlife: consistent low (72% of total), decreasing (6.4%), early-increasing (7.3%), late-increasing (5.5%), and consistent high (8.4%). In age and site-adjusted models, the odds of having greater SCVD burden were 70% higher among women living in consistently high poverty neighborhoods (OR=1.70, 95% CI: 1.14-2.54), 52% higher among women experiencing early increases in neighborhood poverty (OR=1.52, 95% CI: 0.97-2.38), and 69% higher among women experiencing late increases in neighborhood poverty (OR=1.69, 95% CI: 1.04-2.74), compared to women living in consistent low poverty throughout midlife. Controlling for social, behavioral, and menopause-associated factors reduced the magnitude and significance of the estimated effects towards the null. Adjusting for baseline age, race/ethnicity, site, education, marital status, employment, alcohol use, smoking, depressive symptoms, physical activity, menopausal status, hypertension, diabetes, and obesity, the estimated odds of greater SCVD burden were 6% higher among women living in consistently high poverty neighborhoods (95% CI: 0.69-1.63), 10% higher among women experiencing early increases in poverty (95% CI: 0.68-1.76), and 17% higher among women experiencing late increases in poverty (95% CI: 0.70-1.94), relative to women living in consistent low poverty neighborhoods across midlife.

Conclusions:
Women living in neighborhoods with higher levels of poverty throughout midlife had greater SCVD burden in early old age. Associations between neighborhood poverty trajectories and SCVD burden were largely accounted for by individual-level social, behavioral, and biomedical confounders.