Introduction:
The neighborhood environment may contribute to cardiovascular disease risk by promoting physical inactivity and/or unhealthy eating, as well as through exposure to chronic psychosocial stress. Elevated serum C-reactive protein (CRP) concentrations have been associated with increased cardiovascular risk in adults and may also be a marker for stress-related inflammation. Whether CRP is associated with stressful neighborhood conditions among children is unknown.
Hypothesis:
We hypothesized that children and adolescents living in neighborhoods characterized by high levels of poverty or crime have higher concentrations of CRP, independent of adiposity.
Methods:
The sample included 395 children 5-18 years of age (50% African American, 46% white, 4% other race; 48% male, 52% female) from 262 households and 102 census tracts in southeastern Louisiana. Serum CRP levels were measured with a high-sensitivity chemiluminescent immunoassay. High risk neighborhoods were defined as those in the upper tertile of either census-tract family poverty (US Census 2000) or of an index of total crime derived from Uniform Crime Report data (CrimeRisk, Applied Geographic Solutions). Multilevel logistic regression analyses that accounted for both family and neighborhood clustering compared children and adolescents with CRP levels >3mg/L to those with levels ≤3 mg/L across high versus low risk census tracts. Analyses also controlled for race, sex, age, and total body fat (kg) measured by dual-energy x-ray absorptiometry.
Results:
In this sample, 16.0% of children had CRP levels higher than 3 mg/L. After adjustment for covariates, and family and neighborhood clustering, total body fat was positively associated with high CRP levels (p<0.0001) and age was negatively associated with higher CRP levels (p=0.001). Race and sex showed no associations. Independent of adiposity, children from census tracts with the highest levels of either crime or poverty had 2.4 (95% CI: 1.1-5.1) times the odds of having high CRP levels when compared to children from other census tracts.
Conclusions:
Children from neighborhoods characterized by high levels of poverty or crime appear to have higher levels of C-reactive protein, a marker of systemic inflammation and cardiovascular risk. Stress may initiate cardiovascular disease starting in childhood. This research identifies neighborhoods at high risk, where early disease screening and prevention efforts may have maximal impact.
Ethnic and sex differences in visceral, subcutaneous, and total body fat in children and adolescents