Neighbourhood socioeconomic position and risks of major chronic diseases and all-cause mortality: a quasi-experimental study

Abstract

ObjectivesThis study estimated the health impacts of neighbourhood socioeconomic position (SEP) among public housing residents. Because applicants to public housing were assigned to housing projects primarily based on factors other than personal choice, we capitalised on a quasirandom source of variation in neighbourhood of residence to obtain more valid estimates of the health impacts of neighbourhood SEP.DesignQuasiexperimental study.SettingGreater Metropolitan Toronto area, Canada.ParticipantsResidents (24 019–28 858 adults age ≥30 years in 1994 for all outcomes except for asthma, for which the sample was expanded to 66 627 individuals age ≥4 years) of public housing on 1 January 1994.Outcome measuresIncident hypertension, diabetes, asthma, and acute myocardial infarction (MI) and all-cause mortality between 1 January 1994 and 31 December 2006. We used multivariate Cox proportional hazards models to estimate hazard ratios (HRs) for the associations between the quartile of census tract-level SEP and the risk of diagnosis of each health outcome as well as death from any cause.ResultsLiving in a public housing project in the second highest neighbourhood SEP quartile (Q3) was associated with lower hazards of acute MI (HR=0.76, 95% CI 0.54 to 1.07; P=0.11), incident asthma (HR=0.80, 95% CI 0.67 to 0.96; P=0.02) and all-cause mortality (HR=0.86, 95% CI 0.73 to 1.01; P=0.06) compared to living in the lowest neighbourhood SEP quartile (Q1), although only the trend for incident asthma reached statistical significance (P for trend=0.04). By contrast, the associations corresponding to living in the highest versus lowest quartile of median household income (Q4 vs Q1) were neither consistent in direction nor significant. The inconsistent associations may partly be attributed to selection and status incongruity.ConclusionThis study provides new evidence compatible with protective influences of higher neighbourhood SEP on health outcomes, particularly asthma.

Social Determinants of Myocardial Infarction Risk and Survival: A Systematic Review

“…Social deprivation was significantly associated with higher mortality for acute myocardial infarction. In a quasi-experimental study in the Toronto, Canada area, Kim et al examined the relation between neighborhood socioeconomic position and risk of myocardial infarction and total mortality [29]. Living in a public housing project in the second highest neighborhood socioeconomic position was non-significantly associated with lower hazards of acute myocardial infarction (hazard ratio = 0.76, 95% CI 0.54, 1.07, p = 0.11) and all-cause mortality (hazard ratio = 0.86, 95% CI 0.73, 1.01, p=0.06).…”

The Mortality Risk and Socioeconomic Vulnerability Associated with High and Low Temperature in Hong Kong

“…The association between health inequities and socioeconomic disparities have been well established [ 10 , 11 , 12 ]. A number of research revealed that such disparities were also existed for health effect induced by temperature [ 13 , 14 ].…”

[Id 36162] Prevalência E Fatores Sociodemográficos Em Hipertensos Amazônicos, Brasil

“…Nos inquéritos epidemiológicos delineados para o estudo de doenças crônicas não transmissíveis a avaliação do nível socioeconômico é embasada no nível de escolaridade e na renda mensal familiar, observando-se taxas maiores de doenças hipertensivas nos níveis socioeconômicos mais baixos 19 . As diferenças socioeconômicas desempenham importante papel nas condições de saúde em decorrência de vários fatores, tais como acesso ao sistema de saúde, grau de informação, compreensão do problema e adesão ao tratamento 20 .…”