Heart Disease Incidence, Deaths Are Higher in Deprived Neighborhoods

People living in neighborhoods defined as deprived — where residents have overall lower education, income and employment levels — are more likely to develop coronary heart disease and die from it than those living in less deprived neighborhoods, a new study finds.

The study, led by Marilyn Winkleby, Ph.D., of Stanford University School of Medicine, analyzed follow-up data for all Swedish adults ages 35 to 74 — 1.9 million women and 1.8 million men — who had lived in Sweden for at least 10 years.

In late 1995, Winkleby and colleagues from the Karolinska Institute in Stockholm and the University of California, San Francisco, identified Swedish adults without any history of coronary heart disease. From 1996 through 2000, the researchers tracked participants to identify who developed coronary heart disease and how many of those people died within a year's time from the disease.

The study appears in the February issue of the American Journal of Preventive Medicine.

"We found a clustering of heart disease and subsequent mortality among both men and women who lived in deprived neighborhoods when compared with those who lived in less deprived neighborhoods," Winkleby said. "The effect of this was strong,"

For women living in high-deprivation neighborhoods, the risk of developing coronary heart disease was 1.9 times higher than for women living in low-deprivation neighborhoods. For men living in these neighborhoods, it was 1.5 times higher.

In addition, both men and women living in the more deprived neighborhoods had death rates from coronary heart disease 1.6 to 1.7 times higher than those living in low-deprivation neighborhoods.

Furthermore, when researchers took into account individual demographics including age, marital status, family income, education and immigration status, the results remained the same.

"The findings suggest that the cumulative health impact of poor neighborhoods on coronary heart disease could be quite large, as it both increases the likelihood of developing heart disease and hastens death once the disease is diagnosed," said Felicia LeClere, Ph.D., of the University of Michigan.

Moreover, just living in this type of neighborhood is enough to increase the risk, the researchers say, even if an individual has an above-average income or education level compared to the overall trends in the neighborhood in which he or she lives.

"We often think that wealth and education can insulate us from the assaults of our immediate environment. The findings of this study suggest that this assumption is misguided," said LeClere, a research scientist with the Inter-University Consortium for Political and Social Research. LeClere was not associated with the study.

In addition, the fact that these disparities were found in Swedish neighborhoods, where people have access to universal health care, suggests that it is not only access but possibly quality of health care that matters. "Quality of care varies across neighborhoods even when you have universal access," Winkleby said.

While the pathways through which neighborhoods may influence health are unclear, high-deprivation neighborhoods may contribute to coronary heart disease via psychosocial stress and limited access to exercise opportunities and affordable, nutritious food. In addition, there may be poor access to high-quality medical care. "Poor neighborhoods constrain their residents by limiting choice," LeClere said.

Winkleby M, Sundquist K, Cubbin C. Inequities in CHD incidence and case fatality by neighborhood deprivation. Am J Prev Med 32(2), 2007.