Neighborhood Environments and Coronary Heart Disease: A Multilevel Analysis

TLDR

Neighborhood environments may be one of the pathways through which social structure shapes coronary heart disease risk. The study examined whether neighborhood socioeconomic characteristics are linked to coronary heart disease prevalence and risk factors, whether these links persist after adjusting for individual social class, and whether individual-level effects differ by neighborhood. The analysis used multilevel models on 12,601 participants from four U.S. communities in the ARIC baseline (1987–1989), linking neighborhood characteristics from 1990 Census block‑group data to individual outcomes. Living in deprived neighborhoods was associated with higher coronary heart disease prevalence and risk factors, generally persisting after adjustment; however, associations varied by race and gender, with African‑American men in Jackson showing paradoxical patterns.

Abstract

The authors investigated whether neighborhood socioeconomic charactenstics are associated with coronary heart disease prevalence and risk factors, whether these associations persist after adjustment for individual-level social class indicators, and whether the effects of individual-level indicators vary across neighborhoods. The study sample consisted of 12,601 persons in four US communities (Washington County, Maryland; Forsyth County, North Carolina; Minneapolis, Minnesota; and Jackson, Mississippi) participating in the baseline examination of the Atherosclerosis Risk in Communities Study (1987–1989). Neighborhood characteristics were obtained from 1990 US Census block-group measures. Multilevel models were used to estimate associations with neighborhood variables after adjustment for individual-level indicators of social class. Living in deprived neighborhoods was associated with increased prevalence of coronary heart disease and increased levels of risk factors, with associations generally persisting after adjustment for individual-level variables. Inconsistent associations were documented for serum cholesterol and disease prevalence in African-American men. For Jackson African-American men living in poor neighborhoods, coronary heart disease prevalence decreased as neighborhood characteristics worsened. Additionally, in African-American men from Jackson, low social class was associated with Increased serum cholesterol in "richer" neighborhoods but decreased serum cholesterol in "poorer" neighborhoods. Neighborhood environments may be one of the pathways through which social structure shapes coronary heart disease risk. Am J Epidemiol 1997;146: 48–63.