Neighborhood of Residence and Incidence of Coronary Heart Disease

doi:10.1056/NEJM200107123450205

Volume 345:99-106		July 12, 2001		Number 2

Neighborhood of Residence and Incidence of Coronary Heart Disease

Ana V. Diez Roux, M.D., Ph.D., Sharon Stein Merkin, M.H.S., Donna Arnett, Ph.D., Lloyd Chambless, Ph.D., Mark Massing, M.D., Ph.D., F. Javier Nieto, M.D., Ph.D., Paul Sorlie, Ph.D., Moyses Szklo, M.D., Dr.P.H., Herman A. Tyroler, M.D., and Robert L. Watson, Ph.D.

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by Marmot, M.

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ABSTRACT

Background Where a person lives is not usually thought of asan independent predictor of his or her health, although physicaland social features of places of residence may affect healthand health-related behavior.

Methods Using data from the Atherosclerosis Risk in CommunitiesStudy, we examined the relation between characteristics of neighborhoodsand the incidence of coronary heart disease. Participants were45 to 64 years of age at base line and were sampled from fourstudy sites in the United States: Forsyth County, North Carolina;Jackson, Mississippi; the northwestern suburbs of Minneapolis;and Washington County, Maryland. As proxies for neighborhoods,we used block groups containing an average of 1000 people, asdefined by the U.S. Census. We constructed a summary score forthe socioeconomic environment of each neighborhood that includedinformation about wealth and income, education, and occupation.

Results During a median of 9.1 years of follow-up, 615 coronaryevents occurred in 13,009 participants. Residents of disadvantagedneighborhoods (those with lower summary scores) had a higherrisk of disease than residents of advantaged neighborhoods,even after we controlled for personal income, education, andoccupation. Hazard ratios for coronary heart disease among low-incomepersons living in the most disadvantaged neighborhoods, as comparedwith high-income persons in the most advantaged neighborhoods,were 3.1 among whites (95 percent confidence interval, 2.1 to4.8) and 2.5 among blacks (95 percent confidence interval, 1.4to 4.5). These associations remained unchanged after adjustmentfor established risk factors for coronary heart disease.

Conclusions Even after controlling for personal income, education,and occupation, we found that living in a disadvantaged neighborhoodis associated with an increased incidence of coronary heartdisease.

Source Information

From the Division of General Medicine, Columbia College of Physicians and Surgeons (A.V.D.R., S.S.M.), and the Division of Epidemiology, Joseph T. Mailman School of Public Health (A.V.D.R.), Columbia University, New York; the Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis (D.A.); the Department of Biostatistics and Collaborative Studies Coordinating Center (L.C.) and the Department of Epidemiology (M.M., H.A.T.), University of North Carolina at Chapel Hill, Chapel Hill; the Department of Epidemiology, Johns Hopkins University School of Hygiene and Public Health, Baltimore (F.J.N., M.S.); the Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md. (P.S.); and the Department of Preventive Medicine, University of Mississippi Medical Center, Jackson (R.L.W.).

Address reprint requests to Dr. Diez Roux at the Division of General Medicine, Columbia Presbyterian Medical Center, 622 W. 168th St., PH9 E., Rm. 105, New York, NY 10032, or at ad290{at}columbia.edu.

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