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Neighborhood deprivation and cardiovascular disease risk factors: Protective and harmful effects

Center on Social Disparities in Health, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA, cubbinc{at}fcm.ucsf.edu

Kristina Sundquist

Department of Family Medicine, Karolinska Institutet, Stockholm, Sweden

Helena Ahlén

Department of Family Medicine, Karolinska Institutet, Stockholm, Sweden

Sven-Erik Johansson

Department of Family Medicine, Karolinska Institutet, Stockholm, Sweden

Marilyn A. Winkleby

Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA

Jan Sundquist

Department of Family Medicine, Karolinska Institutet, Stockholm, Sweden

Aims: To determine whether neighborhood-level deprivation is independently associated with cardiovascular disease (CVD) health behaviors/risk factors in the Swedish population. Methods: Pooled cross-sectional data, Swedish Annual Level of Living Survey (1996—2000) linked with indicators of neighborhood-level (i.e. Small Area Market Statistics areas) deprivation (1997), to examine the association between neighborhood-level deprivation and individual-level smoking, physical inactivity, obesity, diabetes, and hypertension among women and men, aged 25—64 (n=18,081). Data were analyzed with a series of logistic regression models that adjusted for individual-level age, gender, marital status, immigration status, urbanization, and a comprehensive measure of socioeconomic status (SES). Interactions were tested to determine whether neighborhood effects varied by SES or length of neighborhood exposure. Results: Living in a neighborhood with low deprivation was protective (i.e. lower odds) for smoking, while living in a neighborhood with high deprivation was harmful (i.e. higher odds) for smoking, physical inactivity, and obesity (compared with living in a neighborhood with moderate deprivation). These associations were significant after adjustment for individual-level characteristics. There was no evidence that the neighborhood deprivation associations varied by individual-level SES or length of neighborhood exposure. Conclusions: Neighborhood-level deprivation exerted important protective and harmful associations with health behaviors/ risk factors related to CVD. The significance to public health is substantial because of the number of persons at risk as well as the serious health consequences of CVD. These results suggest that interventions focusing on changing contextual aspects of neighborhoods, in addition to changing individual behaviors, may have a greater impact on CVD than a sole focus on individuals.

Key Words: Cardiovascular disease • deprivation • diabetes • hypertension • neighbourhood • obesity • physical activity • smoking

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