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      Impact of neighborhood resources on cardiovascular disease: a nationwide six-year follow-up

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          Abstract

          Background

          Living in a socially deprived neighborhood is associated with lifestyle risk factors, e.g., smoking, physical inactivity and unhealthy diet, as well as an increased risk of cardiovascular disease, i.e., coronary heart disease and stroke. The aim was to study whether the odds of cardiovascular disease vary with the neighbourhood availability of potentially health-damaging and health-promoting resources.

          Methods

          A nationwide sample of 2 040 826 men and 2 153 426 women aged 35–80 years were followed for six years for first hospitalization of coronary heart disease or stroke. Neighborhood availability of health-damaging resources (i.e., fast-food restaurants and bars/pubs) and health-promoting resources (i.e., health care facilities and physical activity facilities) were determined by use of geographic information systems (GIS).

          Results

          We found small or modestly increased odds ratios (ORs) for both coronary heart disease and stroke, related to the availability of both health-damaging and health-promoting resources. For example, in women, the unadjusted OR (95 % confidence interval) for stroke in relation to availability of fast-food restaurants was 1.18 (1.15–1.21). Similar patterns were observed in men, with an OR = 1.08 (1.05–1.10). However, the associations became weaker or disappeared after adjustment for neighborhood-level deprivation and individual-level age and income.

          Conclusions

          This six year follow-up study shows that neighborhood availability of potentially health-damaging as well as health-promoting resources may make a small contribution to the risk of coronary heart disease and stroke. However, most of these associations were attenuated or disappeared after adjustment for neighborhood-level deprivation and individual-level age and income. Future studies are needed to further examine factors in the causal pathway between neighborhood deprivation and cardiovascular disease.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12889-016-3293-5) contains supplementary material, which is available to authorized users.

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          Most cited references33

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          Neighborhood of residence and incidence of coronary heart disease.

          Where a person lives is not usually thought of as an independent predictor of his or her health, although physical and social features of places of residence may affect health and health-related behavior. Using data from the Atherosclerosis Risk in Communities Study, we examined the relation between characteristics of neighborhoods and the incidence of coronary heart disease. Participants were 45 to 64 years of age at base line and were sampled from four study sites in the United States: Forsyth County, North Carolina; Jackson, Mississippi; the northwestern suburbs of Minneapolis; and Washington County, Maryland. As proxies for neighborhoods, we used block groups containing an average of 1000 people, as defined by the U.S. Census. We constructed a summary score for the socioeconomic environment of each neighborhood that included information about wealth and income, education, and occupation. During a median of 9.1 years of follow-up, 615 coronary events occurred in 13,009 participants. Residents of disadvantaged neighborhoods (those with lower summary scores) had a higher risk of disease than residents of advantaged neighborhoods, even after we controlled for personal income, education, and occupation. Hazard ratios for coronary events in the most disadvantaged group of neighborhoods as compared with the most advantaged group--adjusted for age, study site, and personal socioeconomic indicators--were 1.7 among whites (95 percent confidence interval, 1.3 to 2.3) and 1.4 among blacks (95 percent confidence interval, 0.9 to 2.0). Neighborhood and personal socioeconomic indicators contributed independently to the risk of disease. Hazard ratios for coronary heart disease among low-income persons living in the most disadvantaged neighborhoods, as compared with high-income persons in the most advantaged neighborhoods were 3.1 among whites (95 percent confidence interval, 2.1 to 4.8) and 2.5 among blacks (95 percent confidence interval, 1.4 to 4.5). These associations remained unchanged after adjustment for established risk factors for coronary heart disease. Even after controlling for personal income, education, and occupation, we found that living in a disadvantaged neighborhood is associated with an increased incidence of coronary heart disease.
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            Do poorer people have poorer access to local resources and facilities? The distribution of local resources by area deprivation in Glasgow, Scotland☆

            It has commonly been suggested that in modern cities individual or household deprivation (for example, low income or education) is amplified by area level deprivation (for example, lack of jobs or good schools), in ways which damage the health of the poorest and increase health inequalities. The aim of this study was to determine the location of a range of resources and exposures by deprivation in a UK city. We examined the location of 42 resources in Glasgow City, Scotland, in 2005–2006, by quintile of small area deprivation. Measures included number per 1000 population, network distance to nearest resource, and percentage of data zones containing at least one of each type of resource. Twelve resources had higher density in, and/or were closer to or more common in, more deprived neighbourhoods: public nurseries, public primary schools, police stations, pharmacies, credit unions, post offices, bus stops, bingo halls, public swimming pools, public sports centres, outdoor play areas, and vacant and derelict land/buildings. Sixteen had higher density in, and/or were closer to, or more common in, more affluent neighbourhoods: public secondary schools, private schools, banks, building societies, museums/art galleries, railway stations, subway stations, tennis courts, bowling greens, private health clubs, private swimming pools, colleges, A & E hospitals, parks, waste disposal sites, and tourist attractions. Private nurseries, Universities, fire stations, general, dental and ophthalmic practices, pawn brokers, ATMs, supermarkets, fast food chains, cafes, public libraries, golf courses, and cinemas showed no clear pattern by deprivation. Thus it appears that in the early 21st century access to resources does not always disadvantage poorer neighbourhoods in the UK. We conclude that we need to ensure that theories and policies are based on up-to-date and context-specific empirical evidence on the distribution of neighbourhood resources, and to engage in further research on interactions between individual and environmental factors in shaping health and health inequalities.
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              Geographic life environments and coronary heart disease: a literature review, theoretical contributions, methodological updates, and a research agenda.

              A growing literature investigates associations between neighborhood social environments and coronary heart disease (CHD). After reviewing the literature, we present a theoretical model of the mechanisms through which geographic life environments may influence CHD, focusing particularly on the social-interactional environment. We suggest that, in addition to the common notions of social cohesion or fragmentation and social disorder, eco-epidemiologists should consider neighborhood identities and stigmatization processes. We posit that neighborhood social interactions affect the wide set of affective, cognitive, and relational experiences individuals have in their neighborhoods, which in turn influence the psycho-cognitive antecedents of behavior and in the end shape health behavior. Finally, we discuss key methodological challenges relevant to the advent of a new generation of neighborhood studies, including the operational definition of neighborhoods, non-residential environments, ecometric measurement, model specification strategies, mediational models, selection processes and notions of empirical/structural confounding, and the relevance of observational versus interventional studies.
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                Author and article information

                Contributors
                susanna.calling@med.lu.se
                xinjun.li@med.lu.se
                naomikawakami0730@gmail.com
                tsuyoshi.hamano@gmail.com
                kristina.sundquist@med.lu.se
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                26 July 2016
                26 July 2016
                2016
                : 16
                : 634
                Affiliations
                [1 ]Department of Clinical Sciences, Center for Primary Health Care Research, Skåne University Hospital, Lund University, Clinical Research Centre (CRC), Building 28, floor 11, Jan Waldenströms gata 35, 205 02, Malmö, Sweden
                [2 ]Waseda Institute of Sport Sciences, Waseda University, Tokorozawa Saitama, Japan
                [3 ]Center for Community-based Health Research and Education (COHRE), Organization for the Promotion of Project Research, Shimane University, Izumo, Japan
                [4 ]Stanford Prevention Research Center, Stanford University, Stanford, CA USA
                Article
                3293
                10.1186/s12889-016-3293-5
                4960746
                27456491
                a325341d-7197-402a-b342-119bded547a5
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 12 March 2016
                : 12 July 2016
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100004359, Vetenskapsrådet;
                Funded by: FundRef http://dx.doi.org/10.13039/100000050, National Heart, Lung, and Blood Institute;
                Award ID: R01HL116381
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2016

                Public health
                cardiovascular disease,follow-up study,multilevel analysis,neighborhood
                Public health
                cardiovascular disease, follow-up study, multilevel analysis, neighborhood

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