Multilevel and spatialtime trend analyses of the prevalence of hypertension in a large urban city in the USA

We aimed to test two hypotheses that (1) there were significant variations in the prevalence of hypertension (HBP) across neighborhoods in the city of Philadelphia and (2) these variations were significantly explained by the variations in the neighborhood physical and socioeconomic environment (PSE). We used data from the Southeastern Pennsylvania Household Health Surveys in 20022004 (study period 1, n=8,567), and in 20082010 (period 2, n=8,747). An index of neighborhood PSE was constructed using multiple specific measures. The associations of HBP with PSE at the neighborhood level and other risk factors at the individual level were examined using multilevel regression analysis. The results show that age-adjusted prevalence of HBP increased from 30.33 to 33.04%from study periods 1 to 2 (p<0.001). An estimate of 44 and 53 % of the variations in the prevalence of HBP could be explained by the variations in neighborhood PSE in study periods 1 and 2, respectively. In conclusion, prevalence of HBP significantly increased from 20022004 to 20082010. Individuals living in neighborhoods with disadvantaged PSE have significantly higher risk of the prevalence of HBP.