Neighborhood Environments and Coronary Heart Disease: A Multilevel Analysis

Abstract

The authors investigated whether neighborhood socioeconomic characteristics are associated with coronary heart disease prevalence and risk factors, whether these associations persist after adjustment for individuai-Iovel 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 Ccmrnunfties Study (1987-1989). Neighborhood characteristics were obtained from 1990 US Census block-group measures. Muttilevel models were used to estimate associations with neighbortood 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 nsk factors, with associations generally persisting after adjustment for individual-level variables. lnconsisten 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 Affican-Ameiican men from Jackson, low social class was associated with Increased seum 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.