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Inequities in CHD Incidence and Case Fatality by Neighborhood Deprivation
Open accessAbstract
Background Research has not firmly established whether living in a deprived neighborhood predicts the incidence and case fatality of coronary heart disease (CHD), and whether effects vary across sociodemographic groups. Methods Prospective follow-up study of all Swedish women and men, aged 35 to 74 (1.9 million women, 1.8 million men). Women and men, without a history of CHD, were assessed on December 31, 1995, and followed from January 1, 1996 through December 31, 2000, for first fatal or nonfatal CHD event (130,024 cases); data were analyzed in 2006. Neighborhood-level deprivation (index of education, income, unemployment, welfare assistance) was categorized as low, moderate, and high deprivation. Results Age-standardized CHD incidence was 1.9 times higher for women and 1.5 times higher for men in high- versus low-deprivation neighborhoods; 1-year case fatality from CHD was 1.6 times higher for women and 1.7 times higher for men in high versus low deprivation neighborhoods. The higher incidence in more deprived neighborhoods was observed across all individual-level sociodemographic groups (age, marital status, family income, education, immigration status, mobility, and urban/rural status). In multilevel logistic regression models, neighborhood deprivation remained significantly associated with both CHD incidence and case fatality for women and men after adjusting for the seven sociodemographic factors (p values <0.01). Effects were slightly stronger for women than men in an ancillary analysis that tested for gender differences. Conclusions The clustering of CHD and subsequent mortality among adults in deprived neighborhoods raises important clinical and public health concerns, and calls for a reframing of health problems to include neighborhood social environments, as they may affect health.
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“The inverse association of socioeconomic status (SES) with all phases of the progression of CVD is well established, from the onset of risk factors through mortality due to CVD [41-45].”
From Prevalence of cardiovascular disease among Asian, Pacific Islander and multi-race populations in Hawai’i and California (2023) · cites this paper as [43]
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Li, X., Sundquist, J., Hamano, T., & Sundquist, K. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16203798 · Cited by 25
Self-citationForsberg, P.-O., Ohlsson, H., & Sundquist, K. (2018) · Health & Place · doi:10.1016/j.healthplace.2017.12.006 · Cited by 24
Self-citationHeart failure in immigrant groups: a cohort study of adults aged 45 years and over in Sweden
Wändell, P. E., Carlsson, A. C., Li, X., Gašević, D., Ärnlöv, J., Holzmann, M. J., Sundquist, J., & Sundquist, K. (2018) · Scandinavian Cardiovascular Journal · doi:10.1080/14017431.2018.1546892 · Cited by 24
Self-citationPreventable Hospitalization Rates and Neighborhood Poverty among New York City Residents, 2008–2013
Bocour, A., & Tria, M. (2016) · Journal of Urban Health · doi:10.1007/s11524-016-0090-5 · Cited by 23
Socioeconomic environment and recurrent coronary events after initial myocardial infarction
Koren, A., Steinberg, D. M., Drory, Y., & Gerber, Y. (2012) · Annals of Epidemiology · doi:10.1016/j.annepidem.2012.04.023 · Cited by 23
Karriker‐Jaffe, K. J., Lönn, S. L., Cook, W. K., Kendler, K. S., & Sundquist, K. (2018) · Health & Place · doi:10.1016/j.healthplace.2017.12.008 · Cited by 24
Self-citationXiao, Q., HEISS, G. M., Kucharska‐Newton, A., Bey, G., Love, S.-A. M., & Whitsel, E. A. (2022) · American Journal of Epidemiology · doi:10.1093/aje/kwac070 · Cited by 23
Karriker‐Jaffe, K. J., Ji, J., Sundquist, J., Kendler, K. S., & Sundquist, K. (2017) · Addiction · doi:10.1111/add.13834 · Cited by 22
Self-citationLi, X., Sundquist, J., Hamano, T., Zöller, B., & Sundquist, K. (2015) · International Journal of Behavioral Medicine · doi:10.1007/s12529-015-9488-9 · Cited by 21
Self-citationKoopman, C., van Oeffelen, A. A. M., Bots, M. L., Engelfriet, P. M., Verschuren, W. M. M., van Rossem, L., van Dis, I., Capewell, S., & Vaartjes, I. C. H. (2012) · BMC Public Health · doi:10.1186/1471-2458-12-617 · Cited by 21
Liu, L., Núñez, A. E., Yu, X., Yin, X., & Eisen, H. J. (2013) · Journal of Urban Health · doi:10.1007/s11524-013-9815-x · Cited by 20
Metadata
- Authors
- Winkleby, M., Sundquist, K., & Cubbin, C.
- Affiliations
- Stanford Medicine (US)
- Karolinska Institutet (SE)
- University of California, San Francisco (US)
- Corresponding author
- Winkleby, Marilyn
- Venue
- American Journal of Preventive Medicine
- Publisher
- Elsevier BV
- Published
- 2007-02
- Volume
- 32
- Issue
- 2
- Pages
- 97-106
- ISSN
- 0749-3797 (ISSN-L)
- PMC
- PMC2225531
- OpenAlex
- W2090289324
- Cited by
- 222
- References
- 48
- Citations by year
- 2026: 3 · 2025: 9 · 2024: 8 · 2023: 13 · 2022: 10 · 2021: 7 · 2020: 6 · 2019: 10 · 2018: 12 · 2017: 14 · 2016: 12 · 2015: 14 · 2014: 15 · 2013: 16 · 2012: 15
- FWCI
- 15.12
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- American Journal of Preventive Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Vetenskapsrådet (K2005-27X-15428-01A)
- National Heart, Lung, and Blood Institute (R01 HL71084, R01HL071084)
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
- Keywords
- coronary artery disease, neighborhood disadvantage, socioeconomic status, CHD incidence, health disparities, gender differences, sociodemographic factors, social environment, multilevel analysis
- MeSH terms
- Adult, Aged, Coronary Disease, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Social Class, Sweden
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