Abstract P2158: Neighborhood poverty, John Henryism, and incident cardiovascular disease events in the Jackson Heart Study

Abstract

Background: John Henryism (JH), or high effort-coping, is common when facing adversity. Little is known about cardiovascular disease (CVD) risk when living in poverty and having to cope with adversity. Objective: Test whether JH moderates the association between neighborhood-level poverty and incident CVD events among African American participants in the Jackson Heart Study (JHS). Hypothesis: High JH will increase the risk of CVD among participants who live in neighborhoods with greater poverty. Methods: JHS participants with complete data and no CVD at baseline (2000-2004) were included (n=2,691, mean age: 52.5 years). We utilized % below poverty as a marker for neighborhood poverty. JH was defined using the 12-item measure for high-effort coping (range: 0 to 36). Three categories were created using a tertile distribution: low JH (<28), moderate JH (29-32) and high JH (>32). Coronary heart disease (CHD) and stroke events were adjudicated from baseline to 2016; heart failure (HF) events were adjudicated from 2005 to 2016. Hazard ratios (HR 95% confidence intervals - CI) estimated the association between neighborhood poverty and CVD, adjusting for demographics, psychosocial factors (i.e., optimism), and risk factors (i.e., diabetes). Moderation by JH was examined via interaction terms and stratification in adjusted models using a p-value <0.05. Results: Median follow-up time was approximately 13 years for CHD and stroke cases and 10 years for HF cases. By 2016, there were 126 CHD, 187 HF, and 93 stroke cases. Greater poverty was associated with a greater risk of CHD [HR 1.37 (95% CI 1.15,1.63)] and HF [HR 1.48 (95% CI 1.29,1.71)]. There was a significant interaction between poverty and JH for CHD (p=<0.0001) and HF (p=<0.001). However, low JH combined with greater poverty was associated with a greater hazard of CHD [HR 1.93 (95% CI 1.34, 2.78)] after full adjustment. Individuals with greater poverty also had a higher risk of HF when reporting low JH [HR 1.58 (95% CI 1.22, 2.03)] and moderate JH [HR 1.53 (95% CI 1.14, 2.06)]. No significant associations were identified for high JH or stroke. Conclusion: Residing in neighborhoods with greater poverty was associated with an increased risk of CHD and HF for individuals who reported low and moderate levels of coping. Low JH may represent lower motivation/ low psychosocial resilience and may increase the risk of heart disease when living in poverty.