Study: quality of neighborhood tied to coronary heart disease

July 11, 2001

CHAPEL HILL - Living in poorer neighborhoods increases the likelihood of developing coronary heart disease, according to a new national study involving more than 13,000 people in four parts of the United States.

As a group, people who lived in better neighborhoods faced a lower risk of heart problems than those from disadvantaged areas, which in this country are often more congested and have higher crime rates, even after controlling for individual income, education, occupation and other factors, the study showed.

Researchers say they aren't sure why.

A report on the work appears in the July 12 issue of the New England Journal of Medicine. Authors include Dr. Ana V. Diez Roux, assistant professor of medicine and public health at Columbia University, and Drs. Lloyd Chambless, research professor of biostatistics, and Herman Tyroler, professor of epidemiology, both at the University of North Carolina at Chapel Hill School of Public Health.

"This is an important study because it confirms what some people have suspected -- that the neighborhood you live in does relate to your getting heart disease eventually," Chambless said. "It doesn't necessarily tell us why, but it suggests that another way of preventing heart disease might be on a neighborhood level.

"Increasing access to health care in selected areas and better targeting of public health messages about diet, weight control, exercise and not smoking are among activities that might help prevent or delay heart problems."

The research involved analyzing data from the continuing UNC-based Atherosclerosis Risk in Communities Study, which began in 1987 with medical examinations of 15,792 people, ages 45 to 64, living in four areas. Those were Forsyth County, N.C; Jackson, Miss.; the northwest suburbs of Minneapolis; and Washington County, Md.

Investigators compared that information over time with specific economic data about neighborhoods in which subjects lived.

Doctors re-examined the participants every three years and contacted them yearly by telephone between visits. The latest paper resulting from the study focused on 13,009 subjects who were followed an average of more than nine years.

During that time, researchers recorded 615 coronary "events," such as fatal and non-fatal heart attacks. Some original subjects were excluded because they had existing heart disease when the study began or because not enough information was available for analysis about where they lived.

"Living in the most disadvantaged group of neighborhoods, as compared with the most advantaged group, was associated with a 70 to 90 percent higher risk of coronary disease in whites and a 30 to 50 percent higher risk in blacks," the authors wrote.

"First we controlled for individual income, education and occupation, and the differences persisted," Roux said. "Then we controlled for measures such as smoking and some measures of diet and physical activity, and the differences were still there. Smoking was more prevalent in disadvantaged neighborhoods, but smoking could not entirely explain the greater incidence of coronary heart disease there."

Quieter, wealthier areas might produce less stress among residents or expose them to less air pollution, she said. Complicated but unhealthy interactions might also occur between stress, for example, and fatty foods, automobile exhaust emissions or other factors.

Dr. Gerardo Heiss, professor of epidemiology at UNC, is principal investigator for the Winston-Salem/Forsyth County site. Chambless serves as director of the ARIC study's coordinating and data management center. He also was statistician for the new neighborhood investigation.
The National Heart, Lung and Blood Institute has supported the ARIC study since the beginning.

Note: Roux can be reached at 212-305-5097, Chambless at 919-962-3264.
UNC News Services contact: David Williamson, 919-962-8596
UNC School of Public Health contact: Lisa Katz, 966-7467

University of North Carolina at Chapel Hill

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