Violent Crime Exposure and Pediatric Cardiovascular Health: A Spatial and Hierarchical Analysis for Low Income Children Living in Boston

Elizabeth McClure, Harvard University
Marcia C. Castro, Harvard University
William Adams, Boston University
Dolores Acevedo-Garcia, Brandeis University
Renee Boynton-Jarrett, Boston University

Exposure to violence in childhood is associated with negative health outcomes. We analyze the relationship between census tract level violent crime rate and rates of two cardiovascular outcomes, hypertension and obesity, among Boston children enrolled in subsidized insurance. We hypothesize that these relationships between violent crime and cardiovascular outcomes are structured by spatial and/or neighborhood level determinants (educational, social and economic, and health opportunity environment). Local Moran’s I measurements show significant spatial autocorrelation in the exposure and the outcomes of interest. Ecological (census tract-level) as well as nested (individuals within census tracts) regression models were used for each outcome. Given the autocorrelation in the variables, spatial lag models were run. We also used neighborhood fixed effects models to assess whether the autocorrelation is induced by administrative district. This study underlines the health implications of violent crime exposure and the importance of considering spatial and neighborhood patterning in assessing its impact.