Neighborhood deprivation and cardiovascular disease risk factors: Protective and harmful effects

Abstract

Aims: To determine whether neighborhood-level deprivation is independently associated with cardiovascular disease (CVD) health behaviors/risk factors in the Swedish population. Methods: Pooled cross-sectional data, Swedish Annual Level of Living Survey (1996—2000) linked with indicators of neighborhood-level (i.e. Small Area Market Statistics areas) deprivation (1997), to examine the association between neighborhood-level deprivation and individual-level smoking, physical inactivity, obesity, diabetes, and hypertension among women and men, aged 25—64 (n=18,081). Data were analyzed with a series of logistic regression models that adjusted for individual-level age, gender, marital status, immigration status, urbanization, and a comprehensive measure of socioeconomic status (SES). Interactions were tested to determine whether neighborhood effects varied by SES or length of neighborhood exposure. Results: Living in a neighborhood with low deprivation was protective (i.e. lower odds) for smoking, while living in a neighborhood with high deprivation was harmful (i.e. higher odds) for smoking, physical inactivity, and obesity (compared with living in a neighborhood with moderate deprivation). These associations were significant after adjustment for individual-level characteristics. There was no evidence that the neighborhood deprivation associations varied by individual-level SES or length of neighborhood exposure. Conclusions: Neighborhood-level deprivation exerted important protective and harmful associations with health behaviors/ risk factors related to CVD. The significance to public health is substantial because of the number of persons at risk as well as the serious health consequences of CVD. These results suggest that interventions focusing on changing contextual aspects of neighborhoods, in addition to changing individual behaviors, may have a greater impact on CVD than a sole focus on individuals.

Keywords

Cardiovascular disease deprivation diabetes hypertension neighbourhood obesity physical activity smoking

Get full access to this article

View all access options for this article.

References

Statistiska Centralbyrån (Statistics Sweden). Dödsorsaksregistret. [The Cause of Death Register, 2004] [electronic source] Last updated: 22 May 2004. Available at: http://www.scb.se/templates/Product____6936.asp [accessed 16 September 2004].

Sundquist K. , Malmstrom M. , Johansson SE Neighbourhood deprivation and incidence of coronary heart disease: A multilevel study of 2.6 million women and men in Sweden. J Epidemiol Community Health 2004;58:71—77.

Sundquist K. , Winkleby M. , Ahlen H. , Johansson SE Neighborhood socioeconomic environment and incidence of coronary heart disease: A follow-up study of 25,319 women and men in Sweden. Am J Epidemiol 2004;159:655—62.

Diez Roux AV , Merkin SS , Arnett D. , Chambless L. , Massing M. , Nieto FJ , et al. Neighborhood of residence and incidence of coronary heart disease. N Engl J Med 2001 ;345:99—106.

Cubbin C. , Hadden WC , Winkleby MA Neighborhood context and cardiovascular disease risk factors: The contribution of material deprivation. Ethnicity Dis 2001 ;11:687—700.

Diez Roux AV , Nieto FJ , Muntaner C. , Tyroler HA , Comstock GW , Shahar E. , et al. Neighborhood environments and coronary heart disease: A multilevel analysis. Am J Epidemiol 1997;146(1):48—63.

Diez Roux AV , Merkin SS , Hannan P. , Jacobs DR , Kiefe CI Area characteristics, individual-level socioeconomic indicators, and smoking in young adults: The coronary artery disease risk development in young adults study. Am J Epidemiol 2003;157:315—26.

Tseng M. , Yeatts K. , Millikan R. , Newman B. Area-level characteristics and smoking in women. Am J Public Health 2001;91:1847—50.

Ross NA , Wolfson MC , Dunn JR , Berthelot JM , Kaplan GA , Lynch JW Relation between income inequality and mortality in Canada and in the United States: Cross sectional assessment using census data and vital statistics . Br Med J 2000;320:898—902.

10.

Kleinschmidt I. , Hills M. , Elliott P. Smoking behaviour can be predicted by neighbourhood deprivation measures. J Epidemiol Community Health 1995;49(Suppl. 2):S72—S77.

11.

Smith GD , Hart C. , Watt G. , Hole D. , Hawthorne V. Individual social class, area-based deprivation, cardiovascular disease risk factors, and mortality: The Renfrew and Paisley Study. J Epidemiol Community Health 1998;52: 399—405.

12.

Ecob R. , Macintyre S.

Small area variations in health related behaviours: Do these depend on the behaviour itself, its measurement, or on personal characteristics?

Health Place 2000;6:261—74.

13.

Reijneveld SA Neighbourhood socioeconomic context and self reported health and smoking: A secondary analysis of data on seven cities . J Epidemiol Community Health 2002;56:935—42.

14.

Yen IH , Kaplan GA Poverty area residence and changes in physical activity level: Evidence from the Alameda County Study. Am J Public Health 1998;88:1709—12.

15.

Ross CE Neighborhood disadvantage and adult depression. J Health Soc Behav 2000;42:177—87.

16.

Ellaway A. , Anderson A. , Macintyre S.

Does area of residence affect body size and shape?

Int J Obes Relat Metab Disord 1997;21:304—8.

17.

Reijneveld SA The impact of individual and area characteristics on urban socioeconomic differences in health and smoking. Int J Epidemiol 1998;27:33—40.

18.

Hart C. , Ecob R. , Smith GD People, places and coronary heart disease risk factors: A multilevel analysis of the Scottish Heart Health Study archive. Soc Sci Med 1997;45:893—902.

19.

Sundquist J. , Malmstrom M. , Johansson SE Cardiovascular risk factors and the neighbourhood environment: A multilevel analysis. Int J Epidemiol 1999;28:841—5.

20.

Wärneryd B. Levnadsförhållanden. Återintervjustudie i undersökningen av levnadsförhållanden 1989 (ULF). [Re-interview in the Survey of Living Conditions 1989]. Stockholm: Statistics Sweden; 1991 . Appendix No. 12.

21.

Sundquist J. Ethnicity , social class and health. A population-based study on the influence of social factors on self-reported illness in 223 Latin American refugees, 333 Finnish and 126 south European labour migrants and 841 Swedish controls . Soc Sci Med 1995;40:777—87.

22.

Sundquist J. , Bayard-Burfield L. , Johansson LM , Johansson SE Impact of ethnicity, violence and acculturation on displaced migrants: Psychological distress and psychosomatic complaints among refugees in Sweden. J Nerv Ment Dis 2000;188:357—65.

23.

Granovetter M. Threshold models of collective behavior. Am J Sociol 1978;83:1420—43.

24.

Winkleby MA , Cubbin C. Influence of individual and neighbourhood socioeconomic status on mortality among black, Mexican-American, and white women and men in the United States. J Epidemiol Community Health 2003; 57:444—52.

25.

LeClere FB , Rogers RG , Peters K. Neighborhood social context and racial differences in women's heart disease mortality. J Health Soc Behav 1998;39:91—107.

26.

Robert SA Socioeconomic position and health: The independent contribution of community socioeconomic context. Ann Rev Sociol 1999;25:489—516.

27.

Robert SA Community-level socioeconomic status effects on adult health. J Health Social Behav 1998 ;39:18—37.

28.

Soobader MJ , LeClere FB Aggregation and the measurement of income inequality: Effects on morbidity. Soc Sci Med 1999;48:733—44.

29.

Diez Roux AV , Chambless L. , Merkin SS , Arnett D. , Eigenbrodt M. , Nieto FJ , et al. Socioeconomic disadvantage and change in blood pressure associated with aging. Circulation 2002;106:703—10.

30.

Blakely TA , Woodward AJ Ecological effects in multi-level studies . J Epidemiol Community Health 2000 ;54:367—74.

31.

Bond Huie SA The concept of neighborhood in health and mortality research. Soc Spectrum 2001;21:341—58.

32.

Diez Roux AV The study of group-level factors in epidemiology: Rethinking variables, study designs, and analytical approaches. Epidemiol Rev 2004;26:104—11.

33.

Tienda M. Poor people and poor places: Deciphering neighborhood effects on poverty outcomes . In: Huber J , editor. Macro—micro linkages in sociology. Newbury Park, CA: Sage Publications; 1991 . p. 244—62.

34.

Osborn DP , Fletcher AE , Smeeth L. , Stirling S. , Bulpitt CJ , Breeze E. , et al. Factors associated with depression in a representative sample of 14,217 people aged 75 and over in the United Kingdom: Results from the MRC trial of assessment and management of older people in the community. Int J Geriatr Psychiatry 2003; 18:623—30.

35.

Prince MJ , Harwood RH , Blizard RA , Thomas A. , Mann AH Social support deficits, loneliness and life events as risk factors for depression in old age. The Gospel Oak Project VI. Psychol Med 1997;27:323—32.

36.

Paykel ES Life events, social support and depression . Acta Psychiatr Scand 1994;377(Suppl.):50—8.

37.

Kivela SL , Kongas-Saviaro P. , Laippala P. , Pahkala K. , Kesti E. Social and psychosocial factors predicting depression in old age: A longitudinal study. Int Psychogeriatr 1996;8:635—44.

38.

Block JP , Scribner RA , DeSalvo KB Fast food, race/ ethnicity, and income: A geographic analysis. Am J Prev Med 2004;27:211—17.

39.

Morland K. , Wing S. , Diez Roux A. , Poole C. Neighborhood characteristics associated with the location of food stores and food service places. Am J Prev Med 2002;22:23—9.