Living in some of Baltimore's poorest and most violent neighborhoods can significantly increase your risk of heart attack or stroke, according to a study by the Johns Hopkins Bloomberg School of Public Health. In the worst areas, the hazard is on a par with being a regular smoker.
The results confirm the suspicions of a small group of urban researchers who in recent years have come to believe that impoverished environments can seriously damage health, even for people not directly touched by violence or who do not have unhealthy eating and lifestyle habits.
Researchers suspect the culprit is the stress of living in communities where gunfire and dilapidated housing are common and where stress-reducing activities such as recreational walks can be dangerous.
"We think of health in terms of medicine and genes and lifestyle," says Dr. Thomas A. Glass, a researcher at the university's Bloomberg School of Public Health and the study's lead author.
"We need to think of it more in terms of environment."
The results held even after Glass made allowances for other risk factors, including high blood pressure, cholesterol levels, diabetes and smoking.
The study, which appears in the latest issue of the American Journal of Public Health, is among the first to look at the link between heart disease and neighborhood. It is the first to focus on Baltimore.
Many studies have found that chronic stress can lead to heart disease. And for many people, living in a bad neighborhood produces stress due to worries about personal safety and life in substandard housing amid blight.
Glass said: "Bad things are happening all the time. You have to be vigilant constantly."
Glass and his colleagues looked at 1,100 people, ages 50 to 70, spread across Baltimore from Guilford to Druid Heights. Glass' study did not look for a causal relationship between neighborhood and heart disease, only an association --- which it found.
Researchers rated 64 neighborhoods, ranking them on a "psychosocial hazards scale" that measured attributes such as rates of murder and other violent crimes, percentage of boarded-up and abandoned buildings, number of 911 calls and per-capita income.
"We measured the things that make these neighborhoods scary," Glass said.
Researchers then looked at the history of cardiovascular disease among study subjects. To be included in the research, the subjects had to have lived in their neighborhood for at least five years.
