Articlehybrid2015

The influence of neighbourhood-level socioeconomic deprivation on cardiovascular disease mortality in older age: longitudinal multilevel analyses from a cohort of older British men

Sheena E Ramsay · Richard William Morris · Peter Hynes Whincup · S. V. Subramanian · Olia Papacosta · LUCY T. LENNON +1 more

68 citations0/0 files storedJournal of Epidemiology & Community Health

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Health disparities and outcomes Cardiovascular Health and Risk Factors Healthcare Systems and Public Health

Abstract

BACKGROUND: Evidence from longitudinal studies on the influence of neighbourhood socioeconomic factors in older age on cardiovascular disease (CVD) mortality is limited. We aimed to investigate the prospective association of neighbourhood-level deprivation in later life with CVD mortality, and assess the underlying role of established cardiovascular risk factors. METHODS: A socially representative cohort of 3924 men, aged 60-79 years in 1998-2000, from 24 British towns, was followed up until 2012 for CVD mortality. Quintiles of the national Index of Multiple Deprivation (IMD), a composite score of neighbourhood-level factors (including income, employment, education, housing and living environment) were used. Multilevel logistic regression with discrete-time models (stratifying follow-up time into months) were used. RESULTS: Over 12 years, 1545 deaths occurred, including 580 from CVD. The risk of CVD mortality showed a graded increase from IMD quintile 1 (least deprived) to 5 (most deprived). Compared to quintile 1, the age-adjusted odds of CVD mortality in quintile 5 were 1.71 (95% CI 1.32 to 2.21), and 1.62 (95% CI 1.23 to 2.13) on further adjustment for individual social class, which was attenuated slightly to 1.44 (95% CI 1.09 to 1.89), but remained statistically significant after adjustment for smoking, body mass index, physical activity and use of alcohol. Further adjustment for blood pressure, high-density lipoprotein cholesterol and prevalent diabetes made little difference. CONCLUSIONS: Neighbourhood-level deprivation was associated with an increased risk of CVD mortality in older people independent of individual-level social class and cardiovascular risk factors. The role of other specific neighbourhood-level factors merits further research.

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References

2010Neighborhoods and health 1998Individual social class, area-based deprivation, cardiovascular disease risk factors, and mortality: the Renfrew and Paisley Study.1998Phantom of the area: poverty-area residence and mortality in the United States.2004Neighbourhood characteristics and mortality in the Atherosclerosis Risk in Communities Study 2004Neighbourhood environments and mortality in an elderly cohort: results from the cardiovascular health study 2004Individual- and Area-Level Socioeconomic Status Variables as Predictors of Mortality in a Cohort of 179,383 Persons 2010Neighborhood Socioeconomic Deprivation and Mortality: NIH-AARP Diet and Health Study 2013Socioeconomic Inequalities in Mortality Rates in Old Age in the World Health Organization Europe Region

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