Dataset Information

Accumulated neighbourhood deprivation and coronary heart disease: a nationwide cohort study from Sweden.

ABSTRACT:

Objective

Neighbourhood deprivation is a recognised predictor of coronary heart disease (CHD). The overall aim was to investigate if accumulated exposure to neighbourhood deprivation resulted in higher odds of CHD.

Design

This is a longitudinal cohort study. Models based on repeated assessments of neighbourhood deprivation as well as single-point-in-time assessments were compared.

Setting

Sweden.

Participants

3?140?657 Swedish men and women without a history of CHD and who had neighbourhood deprivation exposure data over the past 15 years.

Primary outcome measures

CHD within 5?years' follow-up.

Results

The results suggested a gradient of stronger association with CHD risk by longer cumulative exposures to neighbourhood deprivation, particularly in the younger age cohorts. Neighbourhood deprivation was also highly correlated over time, especially in older age cohorts.

Conclusions

The effect of neighbourhood deprivation on CHD might depend on age. Accounting for individuals' baseline age may therefore be important for understanding neighbourhood environmental effects on the development of CHD over time. However, because of high correlation of neighbourhood deprivation over time, single-point-in-time assessments may be adequate for CHD risk prediction especially in older adults.

SUBMITTER: Lonn SL

PROVIDER: S-EPMC6756571 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Publications

Accumulated neighbourhood deprivation and coronary heart disease: a nationwide cohort study from Sweden.

Lönn Sara Larsson SL Melander Olle O Crump Casey C Sundquist Kristina K

BMJ open 20190917 9

<h4>Objective</h4>Neighbourhood deprivation is a recognised predictor of coronary heart disease (CHD). The overall aim was to investigate if accumulated exposure to neighbourhood deprivation resulted in higher odds of CHD.<h4>Design</h4>This is a longitudinal cohort study. Models based on repeated assessments of neighbourhood deprivation as well as single-point-in-time assessments were compared.<h4>Setting</h4>Sweden.<h4>Participants</h4>3 140 657 Swedish men and women without a history of CHD a ...[more]

PMID: 31530598

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Project description:The purpose of the study is to examine whether there is an association between neighbourhood deprivation and incidence of congenital heart disease (CHD), after accounting for family- and individual-level potential confounders.All children aged 0 to 11 years and living in Sweden (n?=?748,951) were followed between January 1, 2000 and December 31, 2010. Data were analysed by multilevel logistic regression, with family- and individual-level characteristics at the first level and level of neighbourhood deprivation at the second level.During the study period, among a total of 748,951 children, 1499 (0.2%) were hospitalised with CHD. Age-adjusted cumulative hospitalisation rates for CHD increased with increasing level of neighbourhood deprivation. In the study population, 1.8 per 1000 and 2.2 per 1000 children in the least and most deprived neighbourhoods, respectively, were hospitalised with CHD. The incidence of hospitalisation for CHD increased with increasing neighbourhood-level deprivation across all family and individual-level socio-demographic categories. The odds ratio (OR) for hospitalisation for CHD for those living in high-deprivation neighbourhoods versus those living in low-deprivation neighbourhoods was 1.23 (95% confidence interval (CI)?=?1.04-1.46). In the full model, which took account for age, paternal and maternal individual-level socio-economic characteristics, comorbidities (e.g. maternal type 2 diabetes, OR?=?3.03; maternal hypertension, OR?=?2.01), and family history of CHD (OR?=?3.27), the odds of CHD were slightly attenuated but did not remain significant in the most deprived neighbourhoods (OR?=?1.20, 95% CI?=?0.99-1.45, p?=?0.057).This study is the largest so far on neighbourhood influences on CHD, and the results suggest that deprived neighbourhoods have higher rates of CHD, which represents important clinical knowledge. However, the association does not seem to be independent of individual- and family-level characteristics.

Project description:BACKGROUND: Certain immune-mediated diseases (IMDs), such as rheumatoid arthritis and systemic lupus erythematosus, have been linked to cardiovascular disorders. We examined whether there is an association between 32 different IMDs and risk of subsequent hospitalization for coronary heart disease (CHD) related to coronary atherosclerosis in a nationwide follow up study in Sweden. METHODS AND FINDINGS: All individuals in Sweden hospitalized with a main diagnosis of an IMD (n = 336,479) without previous or coexisting CHD, between January 1, 1964 and December 31 2008, were followed for first hospitalization for CHD. The reference population was the total population of Sweden. Standardized incidence ratios (SIRs) for CHD were calculated. Overall risk of CHD during the first year after hospitalization for an IMD was 2.92 (95% CI 2.84-2.99). Twenty-seven of the 32 IMDs studied were associated with an increased risk of CHD during the first year after hospitalization. The overall risk of CHD decreased over time, from 1.75 after 1-5 years (95% CI 1.73-1.78), to 1.43 after 5-10 years (95% CI 1.41-1.46) and 1.28 after 10+ years (95% CI 1.26-1.30). Females generally had higher SIRs than males. The IMDs for which the SIRs of CDH were highest during the first year after hospitalization included chorea minor 6.98 (95% CI 1.32-20.65), systemic lupus erythematosus 4.94 (95% CI 4.15-5.83), rheumatic fever 4.65 (95% CI 3.53-6.01), Hashimoto's thyroiditis 4.30 (95% CI 3.87-4.75), polymyositis/dermatomyositis 3.81 (95% CI 2.62-5.35), polyarteritis nodosa 3.81 (95% CI 2.72-5.19), rheumatoid arthritis 3.72 (95% CI 3.56-3.88), systemic sclerosis 3.44 (95% CI 2.86-4.09), primary biliary cirrhosis 3.32 (95% CI 2.34-4.58), and autoimmune hemolytic anemia 3.17 (95% CI 2.16-4.47). CONCLUSIONS: Most IMDs are associated with increased risk of CHD in the first year after hospital admission. Our findings suggest that many hospitalized IMDs are tightly linked to coronary atherosclerosis.

Dataset Information

Accumulated neighbourhood deprivation and coronary heart disease: a nationwide cohort study from Sweden.

Objective

Design

Setting

Participants

Primary outcome measures

Results

Conclusions

Publications

Accumulated neighbourhood deprivation and coronary heart disease: a nationwide cohort study from Sweden.

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