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

• Published in: Scandinavian journal of public health 2006, Vol.34 (3), p.228-237
• Main Authors: CUBBIN, CATHERINE, SUNDQUIST, KRISTINA, AHLÉN, HELENA, JOHANSSON, SVEN-ERIK, WINKLEBY, MARILYN A., SUNDQUIST, JAN
• Format: Article
• Language: English
• Subjects: Adult; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular diseases; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - ethnology; Cardiovascular Diseases - etiology; Cardiovascular Diseases - prevention & control; Deprivation; Deprived areas; Diabetes Mellitus, Type 2 - complications; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Health Behavior; Humans; Hypertension - complications; Individual differences; Life Style; Male; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Miscellaneous; Neighbourhoods; Obesity - complications; ORIGINAL ARTICLES; Public health. Hygiene; Public health. Hygiene-occupational medicine; Residence Characteristics; Risk Factors; Smoking - adverse effects; Socioeconomic Factors; Socioeconomic status; Sweden - epidemiology; Sweden - ethnology
• ISSN: 1403-4948; 0300-8037; 1651-1905
• DOI: 10.1080/14034940500327935

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.