New England Journal of Medicine
 Volume 345:99-106

July 12, 2001
                                                            Number 2



Neighborhood of Residence and Incidence of Coronary Heart
                                          Disease
     Ana V. Diez Roux, M.D., Ph.D., Sharon Stein Merkin, M.H.S., Donna Arnett,
Ph.D., Lloyd
  Chambless, Ph.D., Mark Massing, M.D., Ph.D., F. Javier Nieto, M.D., Ph.D.,
Paul Sorlie, Ph.D.,
       Moyses Szklo, M.D., Dr.P.H., Herman A. Tyroler, M.D., and Robert L.
Watson, Ph.D.

ABSTRACT

Background 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.

Methods 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.

Results 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 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.

Conclusions 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.


Source Information

From the Division of General Medicine, Columbia College of Physicians and
Surgeons (A.V.D.R., S.S.M.), and the Division of Epidemiology,
Joseph T. Mailman School of Public Health (A.V.D.R.), Columbia University, New
York; the Division of Epidemiology, School of Public
Health, University of Minnesota, Minneapolis (D.A.); the Department of
Biostatistics and Collaborative Studies Coordinating Center (L.C.)
and the Department of Epidemiology (M.M., H.A.T.), University of North Carolina
at Chapel Hill, Chapel Hill; the Department of
Epidemiology, Johns Hopkins University School of Hygiene and Public Health,
Baltimore (F.J.N., M.S.); the Division of Epidemiology and
Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md.
(P.S.); and the Department of Preventive Medicine,
University of Mississippi Medical Center, Jackson (R.L.W.).

Address reprint requests to Dr. Diez Roux at the Division of General Medicine,
Columbia Presbyterian Medical Center, 622 W. 168th St., PH9
E., Rm. 105, New York, NY 10032, or at [log in to unmask]

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