Neighborhood, Race, and Cardiometabolic Health: A Legal Epidemiological Analysis of Greenville County, South Carolina.

Using legal epidemiological and social determinants of health frameworks, this study examines how racial and spatial inequalities shape cardiometabolic health outcomes in Greenville County, South Carolina. We used Census tract-level data from the CDC PLACES project, and the U.S. Census Bureau to assess associations between racial/ethnic composition and cardiometabolic indicators, including coronary heart disease, hypertension, and obesity. Our regression-based mediation analysis examined whether socioeconomic factors (household income and education attainment) explained these associations. Tracts with greater Black and Hispanic/Latino populations had much higher cardiometabolic disease and risk factor rates. These inequities were partly mediated by lower educational attainment and income, emphasizing the role socioeconomic inequality plays in emergence of racial and spatial disparities of health outcomes in these communities. The results demonstrate the way structural inequities ingrained in land-use policy, education opportunities, and neighborhood characteristics contribute to racial inequities for the health of our communities. Policies that expand access to education and economic opportunities, ensure fair land use, and promote equitable urban and regional planning are critical for reducing health inequity in rapidly growing medium sized regions in the U.S.