Abstract MP24: Neighborhood Cohesion And Violence In Port-au-Prince, Haiti, And Their Relationship To Cardiovascular Risk Factors Of Stress, Depression, And Blood Pressure

Introduction: Neighborhood social context including violence and cohesion may impact cardiovascular disease risk factors in countries like Haiti with high civil unrest. We describe these factors using validated instruments (Neighborhood Collective Efficacy, City Stress Inventory), and hypothesized higher cohesion and lower violence were associated with lower stress, depression, blood pressure (BP), and hypertension. Methods: We collected data from a population-representative cohort of adults in Port-au-Prince, Haiti between March 2019 to April 2021, including stress (Perceived Stress Scale), depression (PHQ-9), blood pressure, and hypertension (SBP ≥ 140 mmHg, DBP ≥ 90 mmHg, or on medications). Adjusting for age and sex, multivariable linear and Poisson regressions assessed the relationship between exposures (neighborhood violence, neighborhood cohesion) and outcomes (stress, depression, BP, hypertension). Results: Among 2,799 adults, 59.7% were female and median age was 41 years (IQR:28-55). Participants reported high cohesion (median 15/25, IQR:14-17) and moderate violence (9/20, IQR:7-11). Stress was moderate (8/16), 12.8% had at least moderate depression, and 30.4% had hypertension. In regressions, higher violence at all levels was associated with higher depressive symptoms (Q4 vs Q1: +2.94 score, 95%CI 2.51, 3.38). Violence was also weakly associated with slightly higher stress (Q4 vs Q1: +0.32 score, 95%CI 0.04, 0.59), and lower hypertension prevalence (Q2 vs Q1: PR 0.86, 95%CI 0.75, 0.99). Cohesion was weakly associated with lower stress (T3 vs T1: -0.43 score, 95%CI -0.71, -0.16), depression (T2 vs T1: -0.63 score, 95%CI -1.02, -0.24), and higher DBP (T2 vs T1: 1.23 mmHg, 95%CI 0.065, 2.39). Conclusions: In conclusion, we found high perceived cohesion and moderate violence. The strongest association was between higher violence and higher depression. Paradoxically, higher violence and lower cohesion were associated with lower hypertension and DBP, possibly due to unmeasured confounding.