Academic journal article Iranian Journal of Public Health

Neighborhood-Level Stress and Circadian Cortisol: A Systematic Review and Meta-Analysis

Academic journal article Iranian Journal of Public Health

Neighborhood-Level Stress and Circadian Cortisol: A Systematic Review and Meta-Analysis

Article excerpt


Investigations of health condition based on neigh- borhood boundaries date back nearly a century (1). However, later, the association between deterio- rated regions and health, including behaviors and physical and mental health outcomes, were stud- ied by Myerson (2). Today, a variety of theoretical and analytical models has identified the direct and indirect pathways between neighborhoods and health. These studies fall into three main domains, physical, psychosocial and biological, or involve a combination of the three. Whereas, there has been more emphasis on the physical and psychosocial aspects, this review emphasizes on biological fac- tors. To be more precise, one of the most signifi- cant currently limitations are the lack of validated biomarkers to prove the underlying mechanisms through which neighborhood affect health.

Cortisol that is produced by stimulation of the hypothalamic-pituitary-adrenal (HPA) axis in re- sponse to stressors has been used as a biomarker in the study of neighborhoods in the last two dec- ades (3-5). Nonetheless, in the study of environ- mental health, using cortisol as a biomarker could lead to the tracking of several health disparities, including cardiovascular disease, obesity and hy- pertension (6-8).

In past decades, different types of cortisol tests have been used to measure distinctive neighbor- hood stressors (9-11). Although there are number of stress biomarkers, cortisol is still the most com- monly used for stress measurements due to the wide regulatory function it does in the nervous system, immune and metabolic system (12). It is one of the key molecules in exposure disease out- comes, which mediate the effect of stress.

On April 7, 2010, which has been nominated as Urban Health Day, the World Health Organiza- tion announced the essential contribution of ur- ban planning as a first action for healthy behaviors and safety. This action significantly increases the chance of people to enjoy better urban living con- ditions. Likewise, understanding of the early roots of health disparities has been emphasized through other organizations such as the American Acade- my of Pediatrics. Health inequalities remain an important public health challenge, and early deaths have excessively been reported in disadvan- taged neighborhoods (13). Despite this large body of literature identifying the significance of assess- ment, there is a lack of evidence from systematic or meta-analysis reviews regarding the biological risk factors in the neighborhood context. The main objective of this study is to assess cortisol as a stress biomarker in the neighborhood context in terms of lower-stress neighborhoods compared with higher-stress neighborhoods.


Data sources

Systematic searches were conducted for studies, which there were no publications status, no lan- guage or publication year limitations. July 26, 2013 was the last date of the searches.

Electronic searches

The following databases were searched as de- scribed in the Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0(14).

A. Bibliographic databases

· Cochrane Central Register of Con- trolled Trials (CENTRAL),



· General search engines; Google scholar, TRIP,

· Subject databases (Communi- tyWISE, Social Care Online, Social Services Abstracts, ASSIA, C2 SPECTR, PsycINFO, Social Pol- icy and Practice, Sociological Ab- stracts),

· Citation indexes (Scopus, SciSearch, Web of knowledge, Social Sciences Citation Index),

· Dissertation and thesis (Index to Theses in Great Britain and Ire- land, ProQuest Dissertation & Theses Database, DissOnline), and

· Gray literature (OpenSIGLE, HMIC, NTIS, PsycEXTRA)

B. Journal and non-bibliographic-data- bases

· BioMed Central,

· PLoS,

· PMC,

· Free Medical Journals,

· HighWire Press, and

· Conference abstracts (Asco, Bio- sis, ISI Proceedings, RRM)

C. …

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