The Neighborhood You Grew Up in May Still Be Written in Your Arteries at 23

Long before the first heart attack, the story of a person’s cardiovascular risk may already have been drafted — not in their genes, and not even primarily in their adult habits, but in the streets, schools and housing blocks that surrounded them as infants. A new study tracking more than 1,100 American young adults from birth to their early twenties reports that the character of the neighborhoods children inhabited during infancy and middle childhood is measurably reflected in their cardiovascular health at around age 23, an age when most people assume their arteries are safely beyond the reach of history. The research, published in the journal SSM – Population Health, applied the American Heart Association’s most rigorous yardstick of cardiovascular health and found that young adults who spent their earliest years in the most deprived urban environments carried scores several points lower than peers from advantaged areas — a gap large enough, at the population scale, to bend trajectories toward heart disease and stroke decades later.

The findings emerge from an unusually ambitious data collection effort known as the Future of Families Cardiovascular Health Among Young Adults, or FF-CHAYA, fielded between September 2021 and December 2023. Its foundation is the Future of Families and Child Wellbeing Study, a longitudinal survey that began by interviewing roughly 5,000 mothers who gave birth between 1998 and 2000 in 20 US cities with populations of at least 200,000. Because the original survey deliberately oversampled births to unmarried mothers, the cohort overrepresents children raised in economically precarious circumstances — precisely the families whose life-course trajectories are most often missing from elite medical cohorts. After a seventh survey wave conducted when participants were about 22, researchers invited 2,507 eligible young adults to traveling “pop-up” clinics, many staged in hotel ballrooms, ultimately running 33 clinics across 22 metropolitan areas. Between 2021 and 2023, 1,421 young adults attended — 56.7 percent of those eligible — sitting for roughly two hours of questionnaires, blood draws, blood pressure readings, anthropometric measurements and ultrasound scans of the carotid artery designed to catch the earliest signs of atherosclerosis.

The clinical centerpiece of the study is Life’s Essential 8, a composite cardiovascular health score formally defined by the American Heart Association in 2022. It aggregates eight metrics — diet, physical activity, nicotine exposure, sleep, body mass index, blood lipids, blood glucose and blood pressure — each scored from 0 to 100, with the overall score computed as the unweighted average of the eight. In FF-CHAYA, diet was estimated with the Dietary Screener Questionnaire used by the National Health and Nutrition Examination Survey, capturing intake of fruits, vegetables, fiber, whole grains, dairy and sugar-sweetened beverages over the previous month, while physical activity came from a validated questionnaire tallying minutes of moderate and vigorous exertion per week. Blood glucose was indexed by hemoglobin A1c, blood lipids by non-HDL cholesterol measured in non-fasting plasma, and blood pressure by averaged second and third readings. Crucially, height, weight and waist circumference were measured directly with calibrated stadiometers and electronic scales rather than self-reported — a critical distinction in a young population, where overt disease is rare, symptoms are quiet and misclassification of risk is common. Sleep, the final component, was derived from reported bedtimes and wake times across workdays and non-workdays.

To characterize the environments in which these children grew up, the team assembled 19 contextual variables describing each child’s census tract or county of residence at birth and at age nine, drawn from the 2000 US Census and Opportunity Insights. The variables spanned income and poverty, education, housing vacancy, employment and occupation, crime, racial and ethnic composition and segregation, and the prevalence of female-headed households. Rather than juggling each variable separately, the researchers applied latent transition analysis, a longitudinal extension of latent class analysis that mines large sets of intercorrelated measures to uncover a small number of unobserved groupings and, crucially, estimates the probability of moving between them over time. The procedure distilled three starkly different neighborhood archetypes: Advantaged, Disadvantaged and Most Disadvantaged. Advantaged tracts combined higher schooling and employment, more managerial and professional workers, less crime, denser physician coverage and lower segregation. The Disadvantaged archetype was distinguished by high proportions of Hispanic and foreign-born residents, while the Most Disadvantaged archetype was marked by predominantly Black populations, single-parent families and intense Black-White segregation. About 79 percent of participants stayed in the same archetype between birth and age nine, while 21 percent moved. Upward movement was not rare: 17 percent of children born in Disadvantaged neighborhoods and 21 percent of those born in the Most Disadvantaged ones had landed in advantaged areas by age nine.

The cardiovascular consequences were visible before any statistical adjustment. The average cardiovascular health score in the analytical sample of 1,182 young adults with complete data was 69.2 out of 100 — well below the 74.9 average reported for contemporary Americans aged 20 to 39, a deficit the authors attribute to the cohort’s deliberate oversampling of disadvantaged families. The architecture of that shortfall is telling. The clinical metrics were comparatively reassuring: blood glucose averaged 94.6, blood lipids 85.9 and blood pressure 83.4 on the 100-point scale. The behavioral metrics collapsed: diet averaged just 39.7 and physical activity 42.7, the two lowest scores in the entire profile, with body mass index at 61.8 and nicotine exposure at 68.2 not far behind. Across neighborhood archetypes, young adults who remained in advantaged areas from birth averaged 72.7, while those who shuttled between Disadvantaged and Most Disadvantaged tracts averaged 63.0. The starkest contrast involved exercise: children who stayed in advantaged neighborhoods scored 56.7 on physical activity, versus a dismal 21.7 among those moving between the two deprived archetypes — a 35-point chasm in a habit that tracks relentlessly into midlife.

Linear regression models quantified the penalties with and without adjustment. In unadjusted models, young adults who stayed in Disadvantaged neighborhoods scored 4.53 points lower on cardiovascular health than those who stayed in Advantaged areas, and those who remained in the Most Disadvantaged neighborhoods scored 6.30 points lower — gaps whose 95 percent confidence intervals comfortably excluded zero. The heaviest burden fell on the small group of children who moved between Disadvantaged and Most Disadvantaged neighborhoods, who carried a 9.75-point deficit. But the picture shifted when the models added individual characteristics: sex, race and ethnicity, age and years of completed schooling. The neighborhood coefficients shrank and lost statistical significance for the stayer groups, while the penalty for shuttling between deprived archetypes persisted at 6.55 points. Meanwhile, each additional year of schooling predicted roughly 2.7 points of cardiovascular health, and being female, Black or Hispanic each independently predicted lower scores. The variance explained tells the same story: a model built on neighborhood archetypes alone accounted for just 4 percent of the differences in cardiovascular health, versus 13 percent once individual sociodemographic factors entered. The authors read this attenuation as evidence that neighborhood deprivation operates largely through, or alongside, the socioeconomic circumstances of the families who live there.

The mechanisms through which a childhood address could imprint itself on the arteries are biologically plausible and extensively studied. Neighborhoods with compromised air quality have been linked to higher rates of coronary heart disease; a scarcity of walkable space and fresh food nudges children toward sedentary routines and calorie-dense diets; and chronic exposure to crime and disorder is thought to sustain stress physiology in ways that promote smoking, inactivity and, downstream, hypertension and metabolic derangement. The developmental origins literature adds a deeper temporal layer: decades of cohort research, popularized as the Barker hypothesis, suggest that conditions in utero and in infancy — when cardiovascular regulatory systems are still being calibrated — shape adult disease risk, in part through epigenetic modifications such as DNA methylation, chemical tags that alter gene expression without changing the underlying genetic code. FF-CHAYA was explicitly designed to probe such mediation: alongside their clinical measurements, participants provided blood samples for methylation profiling. The idea is that the environment of the first years of life may leave a molecular ledger — a record of deprivation written into patterns of gene regulation — that can be read decades later in the vasculature.

The study also fills a conspicuous hole in the existing literature. Landmark cohorts such as the Multi-Ethnic Study of Atherosclerosis, the Atherosclerosis Risk in Communities study, the Jackson Heart Study and CARDIA have produced decades of insight into how surroundings shape the heart, but they recruit adults in midlife or later — MESA’s participants were 45 to 84 at enrollment — and none recorded the neighborhood conditions of their subjects’ childhoods. CARDIA, which began with 18-to-30-year-olds in 1985-86, came closest on age but missed both early-life context and the obesogenic environment that today’s children have grown up in, an era in which childhood obesity has risen especially fast among Black, Hispanic, multiracial and American Indian/Alaska Native youth. The new cohort, by contrast, was born into that environment, spread across 20 metropolitan areas rather than a handful of research sites, and directly measured most of its clinical variables. Recent work suggesting that cardiovascular health begins declining as early as age 10, driven primarily by behaviors rather than clinical factors, sharpens the significance of the behavioral deficits — miserable diet and exercise scores — that dominated this cohort’s profile.

The authors are careful about the limits of their design. The contextual data describe the year 2000, so a tract that gentrified or deteriorated over two decades is frozen in its millennial snapshot; the “neighborhoods” are census tracts and counties, units far larger than what residents would call a neighborhood; and observational data of this kind cannot fully disentangle the effect of place from the families who choose, or are forced, into it. Nor can the study yet capture the slow-burning clinical consequences — hypertension, hyperlipidemia, diabetes — that may emerge as the cohort ages into the decades when cardiovascular disease typically strikes. Still, the implications are difficult to dismiss. Cardiovascular disease remains the leading cause of death in the United States and most of the world, and the strongest risk gradients are laid down in the first decades of life. If a penalty of more than six points clings to children who merely trade one deprived neighborhood for another, the case for treating childhood environments — housing, schools, food access, safety — as genuine cardiovascular infrastructure becomes harder to ignore. By the time a cohort born in 1998 reached 23, their childhood addresses were still legible in their bodies. The question now is whether anything can be done to erase them.