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Am J Public Health. 2014 May;104(5):904-10. doi: 10.2105/AJPH.2013.301707. Epub 2014 Mar 13.

Life-course accumulation of neighborhood disadvantage and allostatic load: empirical integration of three social determinants of health frameworks.

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Per E. Gustafsson and Anne Hammarström are with the Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden. Miguel San Sebastian and Urban Janlert are with the Departments of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University. Töres Theorell and Hugo Westerlund are with the Stress Research Institute, Stockholm University, Stockholm, Sweden.



We examined if the accumulation of neighborhood disadvantages from adolescence to mid-adulthood were related to allostatic load, a measure of cumulative biological risk, in mid-adulthood, and explored whether this association was similar in women and men.


Data were from the participants in the Northern Swedish Cohort (analytical n = 818) at ages 16, 21, 30, and 43 years in 1981, 1986, 1995, and 2008. Personal living conditions were self-reported at each wave. At age 43 years, 12 biological markers were measured to operationalize allostatic load. Registered data for all residents in the cohort participants' neighborhoods at each wave were used to construct a cumulative measure of neighborhood disadvantage. Associations were examined in ordinary least-squares regression models.


We found that cumulative neighborhood disadvantage between ages 16 and 43 years was related to higher allostatic load at age 43 years after adjusting for personal living conditions in the total sample (B = 0.11; P = .004) and in men (B = 0.16; P = .004), but not in women (B = 0.07; P = .248).


Our findings suggested that neighborhood disadvantage acted cumulatively over the life course on biological wear and tear, and exemplified the gains of integrating social determinants of health frameworks.

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