Top

Published in:

01-01-2009 | Cardiovascular Disease

Subclinical coronary atherosclerosis and neighbourhood deprivation in an urban region

Authors: Nico Dragano, Barbara Hoffmann, Andreas Stang, Susanne Moebus, Pablo E. Verde, Simone Weyers, Stefan Möhlenkamp, Axel Schmermund, Klaus Mann, Karl-Heinz Jöckel, Raimund Erbel, Johannes Siegrist, Heinz Nixdorf Recall Study Investigative Group

Published in: European Journal of Epidemiology | Issue 1/2009

Abstract

Inhabitants of deprived neighbourhoods are at higher risk of coronary heart disease. In this study we investigate the hypothesis that social inequalities at neighbourhood level become already manifest in subclinical coronary atherosclerosis, as defined by electron-beam computed tomography derived measures. Coronary artery calcification was assessed as a marker of atherosclerosis in a population based sample of 4301 men and women (45–75 years) without a history of coronary heart disease. Participants lived in three adjacent cities in Germany and were examined between 2000 and 2003 as part of the Heinz Nixdorf Recall Study. Individual level data was combined with neighbourhood level information about unemployment, welfare and living space per inhabitant. This dataset was analysed with descriptive and multilevel regression methods. An association between neighbourhood deprivation and subclinical coronary calcification was observed. After adjustment for age and individual socioeconomic status male inhabitants of high unemployment neighbourhoods had an odds ratio of 1.45 (1.11, 1.96) of exhibiting a high calcification score (>75th percentile) compared to men living in low unemployment areas. The respective odds for women was 1.29 (0.97, 1.70). Additional explorative analyses suggest that clustering of unhealthy lifestyles in deprived neighbourhoods contributes to the observed association. In conclusion, findings suggest that certain neighbourhood characteristics promote the emergence of coronary atherosclerosis. This might point to a pathway from neighbourhood deprivation to manifest coronary heart disease.

Borrell LN, Diez Roux AV, Rose K, Catellier D, Clark BL. Atherosclerosis Risk in Communities Study. Neighbourhood characteristics and mortality in the Atherosclerosis Risk in Communities Study. Int J Epidemiol. 2004;33:398–407. doi:10.1093/ije/dyh063.CrossRefPubMed

Chaix B, Rosvall M, Merlo J. Recent increase of neighborhood socioeconomic effects on ischemic heart disease mortality: a multilevel survival analysis of two large Swedish cohorts. Am J Epidemiol. 2007;165:22–6. doi:10.1093/aje/kwj322.CrossRefPubMed

Diez Roux AV, Merkin SS, Arnett D, Chambless L, Massing M, Nieto FJ, et al. Neighborhood of residence and incidence of coronary heart disease. N Engl J Med. 2001;345:99–106. doi:10.1056/NEJM200107123450205.CrossRefPubMed

Diez Roux AV, Borrell LN, Haan M, Jackson SA, Schultz R. Neighbourhood environments and mortality in an elderly cohort: results from the cardiovascular health study. J Epidemiol Community Health. 2004;58:917–23. doi:10.1136/jech.2003.019596.CrossRefPubMed

Engstrom G, Goransson M, Hansen O, Hedblad B, Tyden P, Todt T, et al. Trends in long-term survival after myocardial infarction: less favourable patterns for patients from deprived areas. J Intern Med. 2000;248:425–34. doi:10.1046/j.1365-2796.2000.00757.x.CrossRefPubMed

Macintyre K, Stewart S, Chalmers J, Pell J, Finlayson A, Boyd J, et al. Relation between socioeconomic deprivation and death from a first myocardial infarction in Scotland: population based analysis. BMJ. 2001;322:1152–3. doi:10.1136/bmj.322.7295.1152.CrossRefPubMed

Stjärne MK, Fritzell J, De Leon AP, Hallqvist J, SHEEP Study Group. Neighborhood socioeconomic context, individual income and myocardial infarction. Epidemiology. 2006;17:14–23. doi:10.1097/01.ede.0000187178.51024.a7.CrossRefPubMed

Forastiere F, Stafoggia M, Tasco C, Picciotto S, Agabiti N, Cesaroni G, et al. Socioeconomic status, particulate air pollution, and daily mortality: differential exposure or differential susceptibility. Am J Ind Med. 2007;50:208–16. doi:10.1002/ajim.20368.CrossRefPubMed

Petersen KL, Bleil ME, McCaffery J, Mackey RH, Sutton-Tyrrell K, Muldoon MF, et al. Community socioeconomic status is associated with carotid artery atherosclerosis in untreated, hypertensive men. Am J Hypertens. 2006;19:560–6. doi:10.1016/j.amjhyper.2005.12.008.CrossRefPubMed

10.

Nordstrom CK, Diez Roux AV, Jackson SA, Gardin JM. Cardovascular Health Study. The association of personal and neighborhood socioeconomic indicators with subclinical cardiovascular disease in an elderly cohort. The cardiovascular health study. Soc Sci Med. 2004;59:2139–47. doi:10.1016/j.socscimed.2004.03.017.CrossRefPubMed

11.

Gee GC, Payne-Sturges DC. Environmental health disparities: a framework integrating psychosocial and environmental concepts. Environ Health Perspect. 2004;112:1645–53.PubMed

12.

van Lenthe FJ, Mackenbach JP. Neighbourhood and individual socioeconomic inequalities in smoking: the role of physical neighbourhood stressors. J Epidemiol Community Health. 2006;60:699–705. doi:10.1136/jech.2005.043851.CrossRefPubMed

13.

Diez-Roux AV. Residential environments and cardiovascular risk. J Urban Health. 2003;80:569–89. doi:10.1093/jurban/jtg065.PubMed

14.

Dragano N, Bobak M, Wege N, Peasey A, Verde PE, Kubinova R, et al. Neighbourhood socioeconomic status and cardiovascular risk factors: a multilevel analysis of nine cities in the Czech Republic and Germany. BMC Public Health. 2007;7:255. doi:10.1186/1471-2458-7-255.CrossRefPubMed

15.

van Lenthe FJ, Brug J, Mackenbach JP. Neighbourhood inequalities in physical inactivity: the role of neighbourhood attractiveness, proximity to local facilities and safety in the Netherlands. Soc Sci Med. 2005;60:763–75. doi:10.1016/j.socscimed.2004.06.013.CrossRefPubMed

16.

Carson AP, Rose KM, Catellier DJ, Kaufman JS, Wyatt SB, Diez-Roux AV, et al. Cumulative socioeconomic status across the life course and subclinical atherosclerosis. Ann Epidemiol. 2007;17:296–303. doi:10.1016/j.annepidem.2006.07.009.CrossRefPubMed

17.

Rosvall M, Engström G, Hedblad B, Janzon L, Berglund G. Area social characteristics and carotid atherosclerosis. Eur J Public Health. 2007;17:333–9. doi:10.1093/eurpub/ckl239.CrossRefPubMed

18.

Wagenknecht LE, Langefeld CD, Freedman BI, Carr JJ, Bowden DW. A comparison of risk factors for calcified atherosclerotic plaque in the coronary, carotid, and abdominal aortic arteries: the diabetes heart study. Am J Epidemiol. 2007;166:340–7. doi:10.1093/aje/kwm091.CrossRefPubMed

19.

Rumberger JA, Simons DB, Fitzpatrick LA, Sheedy PF, Schwartz RS. Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area. A histopathologic correlative study. Circulation. 1995;92:2157–62.PubMed

20.

Lamonte MJ, Fitzgerald SJ, Church TS, Barlow CE, Radford NB, Levine BD, et al. Coronary artery calcium score and coronary heart disease events in a large cohort of asymptomatic men and women. Am J Epidemiol. 2005;162:421–9. doi:10.1093/aje/kwi228.CrossRefPubMed

21.

Schmermund A, Möhlenkamp S, Stang A, Grönemeyer D, Seibel R, Hirche H, et al. Assessment of clinically silent atherosclerotic disease and established and novel risk factors for predicting myocardial infarction and cardiac death in healthy middle-aged subjects: rationale and design of the Heinz Nixdorf Recall Study. Am Heart J. 2002;144:212–8. doi:10.1067/mhj.2002.123579.CrossRefPubMed

22.

Stang A, Moebus S, Dragano N, Beck E, Möhlenkamp S, Schmermund A, et al. Baseline recruitment and analyses of nonresponse of the Heinz Nixdorf Recall Study: identifiability of phone numbers as the major determinant of response. Eur J Epidemiol. 2005;20:489–96. doi:10.1007/s10654-005-5529-z.CrossRefPubMed

23.

Schmermund A, Möhlenkamp S, Berenbein S, Pump H, Moebus S, Roggenbuck U, et al. Population-based assessment of subclinical coronary atherosclerosis using electron-beam computed tomography. Atherosclerosis. 2006;185:177–82. doi:10.1016/j.atherosclerosis.2005.06.003.CrossRefPubMed

24.

Schmermund A, Lehmann N, Bielak LF, Yu P, Sheedy PF, Cassidy-Bushrow AE, et al. Comparison of subclinical coronary atherosclerosis and risk factors in unselected populations in Germany and US-America. Atherosclerosis. 2007;195:e207–16. doi:10.1016/j.atherosclerosis.2007.04.009.CrossRefPubMed

25.

Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15:827–32.PubMedCrossRef

26.

Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001;285:2486–97. doi:10.1001/jama.285.19.2486

27.

UNESCO. International Standard Classification of Education. ISCED 1997. Paris: UNESCO; 1997.

28.

Hoffmann B, Moebus S, Stang A, Beck E, Dragano N, Möhlenkamp S, et al. Residence close to high traffic and prevalence of coronary heart disease. Eur Heart J. 2006;27:2696–702. doi:10.1093/eurheartj/ehl278.CrossRefPubMed

29.

Naess O, Piro FN, Nafstad P, Davey Smith G, Leyland AH. Air pollution, social deprivation, and mortality. A multilevel cohort study. Epidemiology. 2007;18:686–94.CrossRefPubMed

30.

Hoffmann B, Moebus S, Möhlenkamp S, Stang A, Lehmann N, Dragano N, et al. Residential exposure to traffic is associated with coronary atherosclerosis. Circulation. 2007;116:489–96. doi:10.1161/CIRCULATIONAHA.107.693622.CrossRefPubMed

31.

Cubbin C, Sundquist K, Ahlen H, Johansson SE, Winkleby MA, Sundquist J. Neighborhood deprivation and cardiovascular disease risk factors: protective and harmful effects. Scand J Public Health. 2006;34:228–37. doi:10.1080/14034940500327935.CrossRefPubMed

32.

Sundquist J, Malmstrom M, Johansson SE. Cardiovascular risk factors and the neighbourhood environment: a multilevel analysis. Int J Epidemiol. 1999;28:841–5. doi:10.1093/ije/28.5.841.CrossRefPubMed

33.

Davey Smith G, Hart C, Watt G, Hole D, Hawthorne V. Individual social class, area-based deprivation, cardiovascular disease risk factors, and mortality: the Renfrew and Paisley study. J Epidemiol Community Health. 1998;52:399–405.CrossRef

34.

Chaix B, Chauvin P. Tobacco and alcohol consumption, sedentary lifestyle and overweightness in France: a multilevel analysis of individual and area-level determinants. Eur J Epidemiol. 2003;18:531–8. doi:10.1023/A:1024642301343.CrossRefPubMed

35.

Stang A, Moebus S, Möhlenkamp S, Dragano N, Schmermund A, Beck EM, et al. Algorithms for converting Hawksley random zero to automated oscillometric blood pressure values and vice versa. Am J Epidemiol. 2006;164:85–94. doi:10.1093/aje/kwj160.CrossRefPubMed

36.

Jackson C, Best N, Richardson S. Hierarchical related regression for combining aggregate and individual data in studies of socio-economic disease risk factors. J R Stat Soc Ser A. 2008;171:159–178.

37.

Breslow NE, Clayton DG. Approximate inference in generalized linear mixed models. J Am Stat Assoc. 1993;88:9–25. doi:10.2307/2290687.CrossRef

38.

Pollitt RA, Kaufman JS, Rose KM, Diez-Roux AV, Zeng D, Heiss G. Early-life and adult socioeconomic status and inflammatory risk markers in adulthood. Eur J Epidemiol. 2007;22:55–66. doi:10.1007/s10654-006-9082-1.CrossRefPubMed

39.

Pickett KE, Pearl M. Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review. J Epidemiol Community Health. 2001;55:111–22. doi:10.1136/jech.55.2.111.CrossRefPubMed

40.

Riva M, Gauvin L, Barnett TA. Toward the next generation of research into small area effects on health: a synthesis of multilevel investigations published since July 1998. J Epidemiol Community Health. 2007;61:853–61. doi:10.1136/jech.2006.050740.CrossRefPubMed

41.

Babisch W. Transportation noise and cardiovascular risk: updated review and synthesis of epidemiological studies indicate that the evidence has increased. Noise Health. 2006;8:1–29.PubMedCrossRef

42.

Kaufman JS, Maclehose RF, Kaufman S. A further critique of the analytic strategy of adjusting for covariates to identify biologic mediation. Epidemiol Perspect Innov. 2004;1(1):4. doi:10.1186/1742-5573-1-4.CrossRefPubMed

43.

Connolly S, O’Reilly D, Rosato M. Increasing inequalities in health: is it an artefact caused by the selective movement of people? Soc Sci Med. 2007;64:2008–15. doi:10.1016/j.socscimed.2007.02.021.CrossRefPubMed

44.

van Lenthe FJ. Aggregate deprivation and effects on health. In: Siegrist J, Marmot M, editors. Social inequalities in health. Oxford: Oxford University Press; 2006. p. 167–192.CrossRef

45.

Chaix B, Merlo J, Subramanian SV, Lynch J, Chauvin P. Comparison of a spatial perspective with the multilevel analytical approach in neighborhood studies: the case of mental and behavioral disorders due to psychoactive substance use in Malmö, Sweden, 2001. Am J Epidemiol. 2005;162:171–82. doi:10.1093/aje/kwi175.CrossRefPubMed

Title: Subclinical coronary atherosclerosis and neighbourhood deprivation in an urban region
Authors: Nico Dragano
Barbara Hoffmann
Andreas Stang
Susanne Moebus
Pablo E. Verde
Simone Weyers
Stefan Möhlenkamp
Axel Schmermund
Klaus Mann
Karl-Heinz Jöckel
Raimund Erbel
Johannes Siegrist
Heinz Nixdorf Recall Study Investigative Group
Publication date: 01-01-2009
Publisher: Springer Netherlands
Published in: European Journal of Epidemiology / Issue 1/2009
Print ISSN: 0393-2990
Electronic ISSN: 1573-7284
DOI: https://doi.org/10.1007/s10654-008-9292-9

At a glance: The STEP trials

Springer Medicine

Subclinical coronary atherosclerosis and neighbourhood deprivation in an urban region

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2009

Up from ‘false positives’ in genetic—and other—epidemiology

The influence of birth weight and body mass in early adulthood on early coronary heart disease risk among Danish men born in 1953

Steve Selvin: Survival analysis for epidemiologic and medical research

Sex ratio patterns according to Asian ethnicity in Québec, 1981–2004

STROBE and STREGA: instruments for improving transparency and quality of reporting scientific results

Strengthening the reporting of genetic association studies (STREGA): an extension of the STROBE statement