Working Paper Series

The Place of Race in Hypertension: How Family Background and Neighborhood Conditions in Childhood


  • Rucker Johnson, Goldman School of Public Policy, University of California, Berkeley


  • Goldman School of Public Policy Working Paper (October 2008)


This paper investigates the role of family background and neighborhood conditions over
the life course, particularly during childhood, in influencing health later in life, with a focus on
the case of hypertension. Most of the black-white difference in life expectancy stem from racial
differences in mortality rates prior to age 65. Thus, understanding sources of racial health
disparities requires the investigation of exposures to socioeconomic conditions and risk factors
earlier in the life cycle. Blacks’ higher prevalence of cardiovascular disease-related risk factors
account for more than half of the racial disparity in life expectancy (Barghaus, Cutler, Fryer, and
Glaeser, 2007), with hypertension the leading culprit.

For a US cohort born between 1951 and 1970, I produce nationally representative
estimates of the onset of hypertension through mid-life by race/ethnicity, childhood
socioeconomic status, and childhood neighborhood poverty. I provide evidence on the
consequences of childhood neighborhood poverty on the risks of hypertension; this is the first
such study of the full US population. I use nationally representative longitudinal data from the
US spanning nearly four decades to estimate hazard models of onset of hypertension. The data
set, the Panel Study of Income Dynamics (PSID), has the additional unique feature of allowing
analyses of siblings and child neighbors throughout much of their life course. I use the
resemblance between neighboring children’s subsequent likelihood of hypertension in adulthood
in comparison to the similarity between siblings to bound the proportion of inequality in this
health condition that can be attributed to disparities in neighborhood and family background. I
estimate four-level hierarchical random effects hazard models of the onset of hypertension, which
provide a better understanding of the relative importance of family and neighborhood
backgrounds. The results demonstrate that both childhood neighborhood conditions and family
background influence the disease process and risk of hypertension later in life.

I find childhood neighborhood poverty and its attendant stressors play an influential role
in shaping risks of onset of hypertension in middle-age. Other notable neighborhood factors that
were shown to influence risks of onset of hypertension in adulthood include childhood
neighborhood crime exposure and county per-pupil school expenditures. Notable family
background factors include birth weight, parental health status, and parental socioeconomic
status. These effects appear linked in part to low intergenerational economic mobility,
particularly among blacks. The results indicate that racial differences in these early life
neighborhood conditions and family background characteristics play a significant role in
explaining racial disparities in hypertension through at least age 50, while contemporaneous
economic factors account for relatively little of the racial disparities in this health condition in

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