Neighborhood Disadvantage, Identity-based Resilience, and Hypertension: The Healthy Aging with Resilient Identities (HARI) Study

Introduction. Perceived neighborhood problems (PNP), such as safety concerns and limited resources, have been linked to elevated hypertension risk through chronic stress pathways. The Identity Vitality Pathology (IVP) framework captures the extent to which individuals experience threats to identity, belonging, and psychosocial vitality in the face of structural disadvantage, and may modify these pathways. Methods. We conducted logistic regression analyses to estimate the association between PNP and hypertension. Models were stratified by race and gender groups (Black women, Black men, White women, White men). Both main effects models and adjusted models included an interaction term between PNP and Identity Vitality Pathology score (IVPS) to assess effect modification. Adjusted models controlled for age, education, perceived support, financial strain, physical activity, diabetes, smoking status, and self-rated health. Interaction terms were used to evaluate whether the association between PNP and hypertension varied by levels of IVPS within each race/gender group. Results. Higher PNP was associated with increased odds of hypertension among White women and men, but not consistently among Black women and men. Identity state moderated this association only among Black women, such that each 1-SD increase in IVPS score was associated with 59% lower odds of hypertension at the highest level of PNP (aOR-0.41; 95% CI: 0.19, 0.88), with no meaningful moderation observed in other groups. Conclusion. Identity state may moderate the association between subjective neighborhood disadvantage and hypertension, particularly among Black women, representing a potentially novel, modifiable protective factor among multiply marginalized persons living in communities with increased risk for hypertension.