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Neighborhood socioeconomic deprivation and residential instability - Effects on incidence of ischemic heart disease and survival after myocardial inforction

Chaix, Basile LU ; Rosvall, Maria LU and Merlo, Juan LU (2007) In Epidemiology 18(1). p.104-111
Abstract
Background: Previous literature has shown that neighborhood socioeconomic position influences the risk of ischemic heart disease, but little is known about the mechanisms linking the residential context to ischemic heart disease incidence and mortality. We examined whether neighborhood socioeconomic position and neighborhood residential stability (as a determinant of social interaction patterns) have an influence on ischemic heart disease risk. Moreover, we investigated whether dissimilar contextual influences operate at different stages of the disease process, ie, on incidence, 1-day case-fatality, and long-term survival after acute myocardial infarction (MI). Methods: Using a large 27-year longitudinal cohort (baseline: 1 January 1996)... (More)
Background: Previous literature has shown that neighborhood socioeconomic position influences the risk of ischemic heart disease, but little is known about the mechanisms linking the residential context to ischemic heart disease incidence and mortality. We examined whether neighborhood socioeconomic position and neighborhood residential stability (as a determinant of social interaction patterns) have an influence on ischemic heart disease risk. Moreover, we investigated whether dissimilar contextual influences operate at different stages of the disease process, ie, on incidence, 1-day case-fatality, and long-term survival after acute myocardial infarction (MI). Methods: Using a large 27-year longitudinal cohort (baseline: 1 January 1996) defined in the Scania region, Sweden, we estimated multilevel survival models adjusted for individual sociodemographic factors and previous diseases of the persons. Results: After adjustment, multilevel survival models indicated that the incidence of ischemic heart disease increased with neighborhood socioeconomic deprivation but was only weakly associated with neighborhood residential instability (for high vs low residential instability, hazard ratio = 1.2; 95% credible interval = t.0-1.4). Conversely, beyond effects of individual and contextual socioeconomic circumstances and distance to the hospital, we saw a markedly higher I-day case-fatality (4.9; 1.8-15) and shorter survival time after MI among individuals still alive 28 days after MI (4.3; 1.2-17) in neighborhoods with a high versus low residential instability. Conclusions: Effects of residential instability on post-MI survival may be mediated by the lower availability of social support in residentially unstable neighborhoods, suggesting a new class of intermediate processes that should be taken into account when investigating contextual influences on ischemic heart disease. Moreover, dissimilar contextual effects may operate at various stages of the disease process (ie, on incidence, case-fatality, and survival after MI). (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Epidemiology
volume
18
issue
1
pages
104 - 111
publisher
Wolters Kluwer Health/LWW
external identifiers
  • wos:000242836700017
  • scopus:33845773379
ISSN
1531-5487
DOI
10.1097/01.ede.0000249573.22856.9a
language
English
LU publication?
yes
id
14c58cef-43c5-4ca1-82a0-7e6edd211ed0 (old id 683416)
alternative location
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=17130687&dopt=Abstract
date added to LUP
2007-12-11 10:51:07
date last changed
2017-08-27 03:50:20
@article{14c58cef-43c5-4ca1-82a0-7e6edd211ed0,
  abstract     = {Background: Previous literature has shown that neighborhood socioeconomic position influences the risk of ischemic heart disease, but little is known about the mechanisms linking the residential context to ischemic heart disease incidence and mortality. We examined whether neighborhood socioeconomic position and neighborhood residential stability (as a determinant of social interaction patterns) have an influence on ischemic heart disease risk. Moreover, we investigated whether dissimilar contextual influences operate at different stages of the disease process, ie, on incidence, 1-day case-fatality, and long-term survival after acute myocardial infarction (MI). Methods: Using a large 27-year longitudinal cohort (baseline: 1 January 1996) defined in the Scania region, Sweden, we estimated multilevel survival models adjusted for individual sociodemographic factors and previous diseases of the persons. Results: After adjustment, multilevel survival models indicated that the incidence of ischemic heart disease increased with neighborhood socioeconomic deprivation but was only weakly associated with neighborhood residential instability (for high vs low residential instability, hazard ratio = 1.2; 95% credible interval = t.0-1.4). Conversely, beyond effects of individual and contextual socioeconomic circumstances and distance to the hospital, we saw a markedly higher I-day case-fatality (4.9; 1.8-15) and shorter survival time after MI among individuals still alive 28 days after MI (4.3; 1.2-17) in neighborhoods with a high versus low residential instability. Conclusions: Effects of residential instability on post-MI survival may be mediated by the lower availability of social support in residentially unstable neighborhoods, suggesting a new class of intermediate processes that should be taken into account when investigating contextual influences on ischemic heart disease. Moreover, dissimilar contextual effects may operate at various stages of the disease process (ie, on incidence, case-fatality, and survival after MI).},
  author       = {Chaix, Basile and Rosvall, Maria and Merlo, Juan},
  issn         = {1531-5487},
  language     = {eng},
  number       = {1},
  pages        = {104--111},
  publisher    = {Wolters Kluwer Health/LWW},
  series       = {Epidemiology},
  title        = {Neighborhood socioeconomic deprivation and residential instability - Effects on incidence of ischemic heart disease and survival after myocardial inforction},
  url          = {http://dx.doi.org/10.1097/01.ede.0000249573.22856.9a},
  volume       = {18},
  year         = {2007},
}