Neighborhood Environments and Coronary Heart Disease: A Multilevel Analysis

Abstract

The authors investigated whether neighborhood socioeconomic characteristics are associated with coronary heart disease prevalence and risk factors, whether these associations persist after adjustment for individual-level social class indicators, and whether the effects of individual-level indicators vary across neighborhoods. The study sample consisted of 12,601 persons in four US communities (Washington County, Maryland; Forsyth County, North Carolina; Minneapolis, Minnesota; and Jackson, Mississippi) participating in the baseline examination of the Atherosclerosis Risk in Communities Study (1987-1989). Neighborhood characteristics were obtained from 1990 US Census block-group measures. Multilevel models were used to estimate associations with neighborhood variables after adjustment for individual-level indicators of social class. Living in deprived neighborhoods was associated with increased prevalence of coronary heart disease and increased levels of risk factors, with associations generally persisting after adjustment for individual-level variables. Inconsistent associations were documented for serum cholesterol and disease prevalence in African-American men. For Jackson African-American men living in poor neighborhoods, coronary heart disease prevalence decreased as neighborhood characteristics worsened. Additionally, in African-American men from Jackson, low social class was associated with increased serum cholesterol in "richer" neighborhoods but decreased serum cholesterol in "poorer" neighborhoods. Neighborhood environments may be one of the pathways through which social structure shapes coronary heart disease risk.

Neighborhood Socioeconomic Status in Relation to Serum Biomarkers in the Black Women’s Health Study

“…Neighborhood SES has been shown to play an important role in health. Several studies have found that persons living in poorer residential neighborhoods have an increased prevalence of cardiovascular risk factors 5 and higher incidence of hypertension, 10 diabetes, 22 obesity, 6 and CVD. 4,45 Diez-Roux and colleagues observed that residence in lower SES neighborhoods was associated with increased odds of smoking, elevated systolic blood pressure, and serum cholesterol levels after adjustment for individual-level variables in the Atherosclerosis Risk in Communities (ARIC) study.…”

“…2,3 Neighborhood socioeconomic status (SES) has been found to be inversely associated with CVD risk. 4,5 In addition, compared to residents of wealthier neighborhoods, residents of disadvantaged neighborhoods are more likely to be overweight or obese, [6][7][8] to smoke, 5,9 and to have higher blood pressure, 5,8,10 lipid levels, 4,8 and glucose levels. 8,11 Inflammation plays a critical role in all stages of the CVD disease process.…”

“…14,15 Black women at all levels of education are more likely to live in poor neighborhoods than are white women [16][17][18][19] ; thus, it is important to determine whether low neighborhood SES is associated with cardiovascular risk factors independent of individual-level SES. Previous studies of neighborhood SES and biomarkers that included black women were limited to low SES communities 5,20 and the elderly 21 or had too few subjects to allow for specific analyses of black women across SES. 14 A study of African-American adults living in Jackson, MS, found that neighborhood disadvantage was associated with higher cumulative biological risk.…”

Impacts of fast food and the food retail environment on overweight and obesity in China: a multilevel latent class cluster approach

“…These studies (8,30,31) applied hierarchical linear modelling or logistic regression. In the current study, we take a latent class (LC) approach and simultaneously identify consumer segments at both the individual level and the food retail environmental level.…”

“…Fast food is high in energy and low in micronutrient density, and fast-food consumption may contribute to the obesity epidemic (4)(5)(6) . Although research on the possible interactions between obesity and characteristics of the food environment is at an early stage and the evidence is currently too weak to draw firm conclusions (7) , US studies suggest that the food environment influences a healthy diet and obesity levels in North America (8)(9)(10) .The clearly observable presence of processed foods, fast-food restaurants, supermarkets and other food outlets as factors determining the rising prevalence of overweight and obesity is a topic of research that is particularly relevant in the context of developed countries. Similar to the changing food retailing landscape in the postWorld War II era in Western countries (11,12) , the food retailing sector in China is experiencing dramatic changes half a century later.…”