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J Epidemiol Community Health. Jan 2004; 58(1): 71–77.
PMCID: PMC1757024

Neighbourhood deprivation and incidence of coronary heart disease: a multilevel study of 2.6 million women and men in Sweden


Study objective: To examine whether neighbourhood deprivation predicts incidence rates of coronary heart disease, beyond age and individual income.

Design: Follow up study from 31 December 1995 to 31 December 1999. Women and men were analysed separately with respect to incidence rates of coronary heart disease. Multilevel logistic regression was used in the analysis with individual level characteristics (age, individual income) at the first level and level of neighbourhood deprivation at the second level. Neighbourhood deprivation was measured at small area market statistics level by the use of Care Need Index.

Setting: Sweden.

Participants: All women and men aged 40–64 in the Swedish population, in total 2.6 million people.

Main results: There was a strong relation between level of neighbourhood deprivation and incidence rates of coronary heart disease for both women and men. In the full model, which took account of individual income, the risk of developing coronary heart disease was 87% higher for women and 42% higher for men in the most deprived neighbourhoods than in the most affluent neighbourhoods. For both women and men the variance at neighbourhood level was over twice the standard error, indicating significant differences in coronary heart disease risk between neighbourhoods.

Conclusions: High levels of neighbourhood deprivation independently predict coronary heart disease for both women and men. Both individual and neighbourhood level approaches are important in health care policies.

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Selected References

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  • Bucher HC, Ragland DR. Socioeconomic indicators and mortality from coronary heart disease and cancer: a 22-year follow-up of middle-aged men. Am J Public Health. 1995 Sep;85(9):1231–1236. [PMC free article] [PubMed]
  • Kunst AE, Groenhof F, Andersen O, Borgan JK, Costa G, Desplanques G, Filakti H, Giraldes M do R, Faggiano F, Harding S, et al. Occupational class and ischemic heart disease mortality in the United States and 11 European countries. Am J Public Health. 1999 Jan;89(1):47–53. [PMC free article] [PubMed]
  • Hemingway H, Shipley M, Macfarlane P, Marmot M. Impact of socioeconomic status on coronary mortality in people with symptoms, electrocardiographic abnormalities, both or neither: the original Whitehall study 25 year follow up. J Epidemiol Community Health. 2000 Jul;54(7):510–516. [PMC free article] [PubMed]
  • Salomaa V, Niemelä M, Miettinen H, Ketonen M, Immonen-Räihä P, Koskinen S, Mähönen M, Lehto S, Vuorenmaa T, Palomäki P, et al. Relationship of socioeconomic status to the incidence and prehospital, 28-day, and 1-year mortality rates of acute coronary events in the FINMONICA myocardial infarction register study. Circulation. 2000 Apr 25;101(16):1913–1918. [PubMed]
  • Wamala SP. Stora sociala skillnader bakom kvinnors risk för kranskärlssjukdom. Okvalificerat jobb och slitningar i familjen avgörande faktorer. Lakartidningen. 2001 Jan 17;98(3):177–181. [PubMed]
  • Kaplan GA, Keil JE. Socioeconomic factors and cardiovascular disease: a review of the literature. Circulation. 1993 Oct;88(4 Pt 1):1973–1998. [PubMed]
  • Kaplan GA. What is the role of the social environment in understanding inequalities in health? Ann N Y Acad Sci. 1999;896:116–119. [PubMed]
  • Wing S, Casper M, Riggan W, Hayes C, Tyroler HA. Socioenvironmental characteristics associated with the onset of decline of ischemic heart disease mortality in the United States. Am J Public Health. 1988 Aug;78(8):923–926. [PMC free article] [PubMed]
  • Mackenbach JP, Looman CW, Kunst AE. Geographic variation in the onset of decline of male ischemic heart disease mortality in The Netherlands. Am J Public Health. 1989 Dec;79(12):1621–1627. [PMC free article] [PubMed]
  • Wing S, Barnett E, Casper M, Tyroler HA. Geographic and socioeconomic variation in the onset of decline of coronary heart disease mortality in white women. Am J Public Health. 1992 Feb;82(2):204–209. [PMC free article] [PubMed]
  • Armstrong D, Barnett E, Casper M, Wing S. Community occupational structure, medical and economic resources, and coronary mortality among U.S. blacks and whites, 1980-1988. Ann Epidemiol. 1998 Apr;8(3):184–191. [PubMed]
  • LeClere FB, Rogers RG, Peters K. Neighborhood social context and racial differences in women's heart disease mortality. J Health Soc Behav. 1998 Jun;39(2):91–107. [PubMed]
  • Diez-Roux AV, Nieto FJ, Muntaner C, Tyroler HA, Comstock GW, Shahar E, Cooper LS, Watson RL, Szklo M. Neighborhood environments and coronary heart disease: a multilevel analysis. Am J Epidemiol. 1997 Jul 1;146(1):48–63. [PubMed]
  • Kölegård Stjärne M, Diderichsen F, Reuterwall C, Hallqvist J. Socioeconomic context in area of living and risk of myocardial infarction: results from Stockholm Heart Epidemiology Program (SHEEP). J Epidemiol Community Health. 2002 Jan;56(1):29–35. [PMC free article] [PubMed]
  • Diez Roux AV, Merkin SS, Arnett D, Chambless L, Massing M, Nieto FJ, Sorlie P, Szklo M, Tyroler HA, Watson RL. Neighborhood of residence and incidence of coronary heart disease. N Engl J Med. 2001 Jul 12;345(2):99–106. [PubMed]
  • Malmström M, Sundquist J, Johansson SE, Johansson LM. The influence of social deprivation as measured by the CNI on psychiatric admissions. Scand J Public Health. 1999 Sep;27(3):189–195. [PubMed]
  • Malmström M, Sundquist J, Bajekal M, Johansson SE. Indices of need and social deprivation for primary health care. Scand J Soc Med. 1998 Jun;26(2):124–130. [PubMed]
  • Sundquist J, Malmström M, Johansson SE. Cardiovascular risk factors and the neighbourhood environment: a multilevel analysis. Int J Epidemiol. 1999 Oct;28(5):841–845. [PubMed]
  • Malmström M, Sundquist J, Bajekal M, Johansson SE. Ten-year trends in all-cause mortality and coronary heart disease mortality in socio-economically diverse neighbourhoods. Public Health. 1999 Nov;113(6):279–284. [PubMed]
  • Larsen K, Petersen JH, Budtz-Jørgensen E, Endahl L. Interpreting parameters in the logistic regression model with random effects. Biometrics. 2000 Sep;56(3):909–914. [PubMed]
  • Callas PW, Pastides H, Hosmer DW. Empirical comparisons of proportional hazards, poisson, and logistic regression modeling of occupational cohort data. Am J Ind Med. 1998 Jan;33(1):33–47. [PubMed]
  • Pappas G, Queen S, Hadden W, Fisher G. The increasing disparity in mortality between socioeconomic groups in the United States, 1960 and 1986. N Engl J Med. 1993 Jul 8;329(2):103–109. [PubMed]
  • Woodward M. Small area statistics as markers for personal social status in the Scottish heart health study. J Epidemiol Community Health. 1996 Oct;50(5):570–576. [PMC free article] [PubMed]
  • Sloggett A, Joshi H. Higher mortality in deprived areas: community or personal disadvantage? BMJ. 1994 Dec 3;309(6967):1470–1474. [PMC free article] [PubMed]
  • Sloggett A, Joshi H. Deprivation indicators as predictors of life events 1981-1992 based on the UK ONS Longitudinal Study. J Epidemiol Community Health. 1998 Apr;52(4):228–233. [PMC free article] [PubMed]
  • Osler Merete, Prescott Eva, Grønbaek Morten, Christensen Ulla, Due Pernille, Engholm Gerda. Income inequality, individual income, and mortality in Danish adults: analysis of pooled data from two cohort studies. BMJ. 2002 Jan 5;324(7328):13–16. [PMC free article] [PubMed]
  • Yen IH, Kaplan GA. Neighborhood social environment and risk of death: multilevel evidence from the Alameda County Study. Am J Epidemiol. 1999 May 15;149(10):898–907. [PubMed]
  • Lochner K, Pamuk E, Makuc D, Kennedy BP, Kawachi I. State-level income inequality and individual mortality risk: a prospective, multilevel study. Am J Public Health. 2001 Mar;91(3):385–391. [PMC free article] [PubMed]
  • Veugelers PJ, Yip AM, Kephart G. Proximate and contextual socioeconomic determinants of mortality: multilevel approaches in a setting with universal health care coverage. Am J Epidemiol. 2001 Oct 15;154(8):725–732. [PubMed]
  • Fleury J, Keller C, Murdaugh C. Social and contextual etiology of coronary heart disease in women. J Womens Health Gend Based Med. 2000 Nov;9(9):967–978. [PubMed]
  • Lynch J, Smith GD, Hillemeier M, Shaw M, Raghunathan T, Kaplan G. Income inequality, the psychosocial environment, and health: comparisons of wealthy nations. Lancet. 2001 Jul 21;358(9277):194–200. [PubMed]
  • Diez-Roux AV. Multilevel analysis in public health research. Annu Rev Public Health. 2000;21:171–192. [PubMed]
  • Krieger N. Theories for social epidemiology in the 21st century: an ecosocial perspective. Int J Epidemiol. 2001 Aug;30(4):668–677. [PubMed]
  • Merlo J. Multilevel analytical approaches in social epidemiology: measures of health variation compared with traditional measures of association. J Epidemiol Community Health. 2003 Aug;57(8):550–552. [PMC free article] [PubMed]
  • Hart C, Ecob R, Smith GD. People, places and coronary heart disease risk factors: a multilevel analysis of the Scottish Heart Health Study archive. Soc Sci Med. 1997 Sep;45(6):893–902. [PubMed]
  • Kaufman JS, Cooper RS, McGee DL. Socioeconomic status and health in blacks and whites: the problem of residual confounding and the resiliency of race. Epidemiology. 1997 Nov;8(6):621–628. [PubMed]
  • Braveman P, Cubbin C, Marchi K, Egerter S, Chavez G. Measuring socioeconomic status/position in studies of racial/ethnic disparities: maternal and infant health. Public Health Rep. 2001 Sep-Oct;116(5):449–463. [PMC free article] [PubMed]

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