Neighborhood Socioeconomic Environment and Incidence of Coronary Heart Disease: a Follow-up Study of 25,319 Women and Men in Sweden
Abstract overview:
This study examines whether a neighborhood’s socioeconomic environment – namely the education and income levels of one’s neighborhood –can predict new cases of coronary heart disease (CHD), and whether the rates of CHD remain the same or change after factoring out individual-level characteristics such as gender, age, education and income, cigarette smoking, and how long a person has lived in the neighborhood.
The study’s strengths include the large sample size (25,319 Swedish citizens), the study design which tracked new cases of CHD (incidence rates), and the small neighborhood units (approximately 1,000 to 2,000 people). Also of note, this study replicated the results of other studies, but did so in a new context.
Neighborhood-level socioeconomic environment was defined as: 1) neighborhood education (the percentage of residents with fewer than 10 years of schooling), and 2) neighborhood income, (the proportion of residents with incomes in the lowest national income bracket).
The study has two major findings: 1) As the level of education and income in a neighborhood decreased, the rates of CHD increased as a gradient. 2) The higher rates of CHD in neighborhoods with lower levels of education and income persisted after factoring out individual-level characteristics. In fact, women and men living in the lowest educated neighborhoods had a 25 percent higher risk of developing CHD than their counterparts living in the highest educated neighborhoods. Both the education level as well as the income level of a neighborhood predicted higher rates of CHD.
Our findings support the mounting scientific evidence from other studies around the world that suggest that neighborhood socioeconomic environment has a direct effect on the health of its residents.
Secondary findings of the study:
Despite their strong association with CHD, individual gender, age, education, income, and cigarette smoking did not account for our findings. The results were not altered significantly when these factors were taken into account.
Implications and recommendations from the study:
How might the education and income level of a neighborhood actually influence CHD? These factors may be associated with information, resources, and/or policies that in turn influence the development or maintenance of heart healthy behaviors. For example, residents in poorer neighborhoods may have less access to smoke-free environments, healthy food stores, safe places to exercise, or medical resources and information related to the prevention and treatment of CHD risk factors.
Our findings suggest that information and resources directed primarily at individuals, with little consideration of neighborhood influences, may not be as effective as a combination of individual- and neighborhood-level approaches. Heart disease prevention programs should combine both individual- and neighborhood-level approaches in order to give all people the opportunity to achieve and maintain better health. This includes efforts that establish policies and programs for safe places to exercise, favor farmer’s markets and healthy food stores and limit fast food restaurants, and enforce anti-smoking ordinances. Such efforts may go a long way toward enhancing the health behaviors of all residents.
Proposed news articles and related information:
- How can neighborhoods be planned and built to maximize health for all residents? Are there effective community models that are both affordable and healthy?
- The Gazette (Montreal) – In environmentally conscious Portland, every bit of green helps, by Susan Semenak; November 23, 2005
- Rand Policy Research -- Does Neighborhood Deterioration Lead to Poor Health?
- The Vermont Forum on Sprawl Initiatives -- Healthy Neighborhoods/Healthy Kids Project Forum
- The Strategic Alliance Enact -- Institute a Safe Routes to School Program to improve safety and promote walking and biking to school.
- How can health professionals better inform entire communities about the health risks that may be present in neighborhoods like smoke-filled public spaces, lack of sidewalks for safe walking, the presence of fast food restaurants near homes? What kinds of community oriented health campaigns work and why?
- The San Diego Union-Tribune -- Binational effort aims to promote Latinos' health. By Leonel Sanchez; October 16, 2003
- CDC -- Reducing Childhood Asthma Through Community-Based Service Delivery --- New York City, 2001—2004; January 14, 2005
