Identification of Resilient and At-Risk Neighborhoods for Cardiovascular Disease Among Black Residents: the Morehouse-Emory Cardiovascular (MECA) Center for Health Equity Study

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A map depicts the study region in the Atlanta, Georgia, metropolitan area with 2010 census tract boundaries delineated. Resilient and at-risk census tracts are indicated as are those that are neither resilient nor at risk. Resilient and at-risk census tracts are located throughout the study area without clustering of either resilient or at-risk tracts, and resilient and at-risk census tracts are also often adjacent to one another. An inset of the figure illustrates the location of the study region in the state of Georgia.

Figure 1.
Study region of the Morehouse–Emory Cardiovascular Center for Health Equity project conducted in the Atlanta, Georgia, metropolitan area with 2010 census tract boundaries. Resilient and at-risk census tracts identified by the residual percentile method are indicated.

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Census tract-level CV outcome data for blacks aged 35 to 64 from 992 census tracts in 36 counties in the Atlanta–Athens-Clarke–Sandy Springs combined statistical area were used. Tracts censored on the basis of having fewer than 5 events for CV mortality and fewer than 6 events for CV morbidity were 645 for CV mortality, 190 for ED visits, and 229 for CV hospitalization. Tracts censored on the basis of having fewer than 200 black residents aged 35 to 64 were 1 for CV mortality, 109 for ED visits, and 88 for CV hospitalization. The number of tracts included were 346 for CV mortality, 693 for ED visits, and 675 for hospitalization. Negative binomial models were built for each of 3 CV outcome rates with covariates of age distribution, percentage male, and median black household income. Tracts excluded for missing covariates were 0 for CV mortality, 4 for CV ED visits, and 4 for CV hospitalization. Number of tracts included in the models after those exclusions were 346 for CV mortality, 689 for CV ED visits, and 671 for CV hospitalizations. We then calculated model residuals of census tracts for each of the 3 CV outcome measures. Tracts with model residuals in the highest 25% were considered at risk for the measure, whereas tracts with model residuals in the lowest 25% were considered resilient for the measure. Census tracts at risk or resilient on at least 2 of 3 measures were finally classified as at-risk or resilient census tracts, respectively. Based on these calculations, the total at-risk census tracts were 121 and the total resilient census tracts was 106.

Figure 2.
The steps in the identification of at-risk and resilient census tracts by the residual percentile method. Census tract-level CV outcome data for blacks aged 35 to 64 from 992 census tracts in 36 counties in the Atlanta–Athens-Clarke–Sandy Springs combined statistical area were used to identify 121 at-risk and 106 resilient census tracts. Abbreviations: CV, cardiovascular; ED, emergency department.

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