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

Longjian Liu, Ana E. Núñez, Xiaoping Yu, Xiaoyan Yin, Howard J. Eisen

Research output: Contribution to journalReview articlepeer-review

12 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1053-1063
Number of pages11
JournalJournal of Urban Health
Issue number6
StatePublished - Dec 2013
Externally publishedYes

Bibliographical note

Funding Information:
L Liu and AE Núñez are partly supported by the US DHHS Office of Women’s Health and Office of Public Health and Service-funded Philadelphia Ujima Study (Mind Spirit Body Health Collaborative, PI: AE Núñez). Grant number 5 CCEWH111020-02-00. The study used data from the Public Health Management Corporation (PHMC) Philadelphia. The responsibility for the analysis and interpretation of these data is solely that of the authors. The opinions expressed in this paper are those of the authors and do not represent the views of PHMC. Our thanks also go to Miss Michelle Klawans and Ms. Deirdre Potter for their careful proofreading of the report.


  • Hypertension
  • Multilevel models
  • Neighborhood environment
  • Urban health


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