Variation in Rates of Fatal Coronary Heart Disease by Neighborhood Socioeconomic Status: The Atherosclerosis Risk in Communities Surveillance (1992–2002)

Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, USA.
Annals of epidemiology (Impact Factor: 2). 04/2011; 21(8):580-8. DOI: 10.1016/j.annepidem.2011.03.004
Source: PubMed


Racial and gender disparities in out-of-hospital deaths from coronary heart disease (CHD) have been well-documented, yet disparities by neighborhood socioeconomic status (nSES) have been less systematically studied in US population-based surveillance efforts.
We examined the association of nSES, classified into tertiles, with 3,743 out-of-hospital fatal CHD events, and a subset of 2,191 events classified as sudden, among persons aged 35 to 74 years in four US communities under surveillance by the Atherosclerosis Risk in Communities (ARIC). Poisson generalized linear mixed models generated age-, race- (white, black) and gender-specific standardized mortality rate ratios and 95% confidence intervals (RR, 95% CI).
Regardless of nSES measure used, inverse associations of nSES with all out-of-hospital fatal CHD and sudden fatal CHD were seen in all race-gender groups. The magnitude of these associations was larger among women than men. Further, among blacks, associations of low nSES (vs. high nSES) were stronger for sudden cardiac deaths (SCD) than for all out-of-hospital fatal CHD.
Low nSES was associated with an increased risk of out-of-hospital CHD death and SCD. Measures of the neighborhood context are useful tools in population-based surveillance efforts for documenting and monitoring socioeconomic disparities in mortality over time.

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    • "Additionally, we examined whether the following parameters modified the nINC – lipid-lowering therapy relationship: race, gender, age, study community and year of MI. Models utilizing tertiles defined by overall nINC cut-points were evaluated, as interpretations of our earlier work in this population did not change based on the delineation (community-specific, race-specific, and overall cut-points) of nINC tertiles [9]. "
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    ABSTRACT: Background Lipid-reduction pharmacotherapy is often employed to reduce morbidity and mortality risk for patients with dyslipidemia or established cardiovascular disease. Associations between socioeconomic factors and the prescribing and use of lipid-lowering agents have been reported in several developed countries. Methods We evaluated the association of census tract-level neighborhood household income (nINC) and lipid-lowering medications received during hospitalization or at discharge among 3,546 (5,335 weighted) myocardial infarction (MI) events in the United States (US) Atherosclerosis Risk In Communities (ARIC) surveillance study (1999–2002). Models included neighborhood household income, race, gender, age, study community, year of MI, hospital type (teaching vs. nonteaching), current or past history of hypertension, diabetes or heart failure, and presence of cardiac pain. Results About fifty-nine percent of patients received lipid-lowering pharmacotherapy during hospitalization or at discharge. Low nINC was associated with a lower likelihood (prevalence ratio 0.89, 95% confidence interval: 0.79, 1.01) of receiving lipid-lowering pharmacotherapy compared to high neighborhood household income, and no significant change in this association resulted when adjusted for the above-mentioned covariates. Conclusion Patient’s socioeconomic status appeared to influence whether they were prescribed a lipid-lowering pharmacotherapy after hospitalization for myocardial infarction in the US ARIC surveillance study (1999–2002).
    BMC Public Health 05/2013; 13(1):488. DOI:10.1186/1471-2458-13-488 · 2.26 Impact Factor
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    • "Previous research investigating relations between neighbourhoods and cardiometabolic diseases has largely represented local residential areas using measures of area-level socioeconomic status. These studies have demonstrated associations between area-level socioeconomic deprivation and ischaemic heart disease mortality [63], coronary heart disease mortality [64, 65], coronary heart disease incidence [5, 6, 66], coronary heart disease risk factors [67], type 2 diabetes incidence [7], and components of the insulin resistance syndrome [68]. Other studies have found that individual socioeconomic factors largely accounted for associations between area deprivation and coronary heart disease [69–72]. "
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    ABSTRACT: A substantial body of research has arisen concerning the relationships between objective residential area features, particularly area-level socioeconomic status and cardiometabolic outcomes. Little research has explored residents' perceptions of such features and how these might relate to cardiometabolic outcomes. Perceptions of environments are influenced by individual and societal factors, and may not correspond to objective reality. Understanding relations between environmental perceptions and health is important for the development of environment interventions. This study evaluated associations between perceptions of local built and social environmental attributes and metabolic syndrome, and tested whether walking behaviour mediated these associations. Individual-level data were drawn from a population-based biomedical cohort study of adults in Adelaide, South Australia (North West Adelaide Health Study). Participants' local-area perceptions were analysed in cross-sectional associations with metabolic syndrome using multilevel regression models (n = 1, 324). A nonparametric bootstrapping procedure evaluated whether walking mediated these associations. Metabolic syndrome was negatively associated with greater local land-use mix, positive aesthetics, and greater infrastructure for walking, and was positively associated with greater perceived crime and barriers to walking. Walking partially mediated associations between metabolic syndrome and perceived environmental features. Initiatives targeting residents' perceptions of local areas may enhance the utility of environmental interventions to improve population health.
    Journal of Environmental and Public Health 09/2012; 2012:589409. DOI:10.1155/2012/589409
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    • "The decline of CHD mortality rates is heterogeneous in countries with higher CHD rates such as Finland, Ireland, and the United Kingdom [4]. CHD mortality rates vary according to social deprivation in Scotland [5], by migration status in England and Wales [6], and by neighborhood score regardless of gender and race in the US [7]. Additionally, an international comparison of six cohorts revealed that the decline in cardiovascular mortality differed according to socioeconomic status [8]. "
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    ABSTRACT: Background: Reductions in heart disease mortality rates are variable according to socioeconomic status. Methods: We performed a time trend analysis of all heart diseases (all circulatory diseases, except rheumatic, cerebrovascular, and aortic diseases) comparing three different household income levels (high, middle, and low) in the city of Sao Paulo from 1996 to 2010. Results: A total of 197,770 deaths were attributed to heart diseases; 62% of them were due to coronary diseases. The rate of death due to heart diseases declined for the city as a whole. The annual percent change (APC) and 95% confidence intervals for men living in the high, middle and low income areas were -4.1 (-4.5 to -3.8), -3.0 (-3.5 to -2.6), and -2.5 (-2.8 to -2.1), respectively. The decline in death rate was greatest among men in the wealthiest area. The trend rates of women living in the high-income area had one joinpoint; APC was -4.4 (-4.8 to -3.9) from 1996-2005 and -2.6 (-3.8 to -1.4) from 2005-2010. Middle and low income areas had an APC of -3.6 (-4.1 to -3.1) and -3.0 (-3.2 to -2.7) from 1996-2010, respectively. During the last 5years of observation, there was a gradient of the decline of the risk of death, faster for people living in the wealthiest area and slower for people living in the more deprived neighborhoods. Conclusion: Reduction in deaths due to heart diseases is greatest for men and women living in the wealthiest neighborhoods.
    International journal of cardiology 08/2012; 167(6). DOI:10.1016/j.ijcard.2012.07.006 · 4.04 Impact Factor
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