Am J Epidemiol 2004; 159:655-662.

Neighborhood Socioeconomic Environment and Incidence of Coronary Heart
Disease: A Follow-up Study of 25,319 Women and Men in Sweden

Kristina Sundquist1 , Marilyn Winkleby2, Helena Ahlén1 and Sven-Erik
Johansson1

1 Department of Family Medicine, Karolinska Institutet, Stockholm, Sweden.
2 Stanford Prevention Research Center, Stanford University School of
Medicine, Palo Alto, CA.

In this study, the authors examined whether neighborhood socioeconomic
environment predicted incident coronary heart disease after adjustment for
individual-level characteristics. A random sample of the Swedish population
(25,319 women and men aged 35?74 years) was interviewed between 1986 and
1993 and was followed through December 1997 for incident coronary heart
disease (1,189 events). Neighborhood socioeconomic environment was defined
by small-area market statistics (6,145 neighborhoods) and measured by two
indicators: neighborhood education (proportion of people with less than 10
years of education in the neighborhood) and neighborhood income (proportion
of people with incomes in the lowest national income quartile). Separate
multilevel Cox proportional hazards models showed that low neighborhood
education and low neighborhood income each predicted incident coronary
heart disease after adjustment for age, sex, and individual-level education
and income (hazard ratios were 1.25 and 1.23, respectively). The  authors
conclude that neighborhood socioeconomic environment predicts incident
coronary heart disease, having a significant effect on coronary heart
disease risk beyond the individual effect.

Key Words: coronary disease; follow-up studies; incidence; regression
analysis; residence characteristics; social class; social environment

Abbreviations: CI, confidence interval; HR, hazard ratio; ICD,
International Classification of Diseases; SAMS, small-area market
statistics.

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