International Journal of Epidemiology, Vol 28, 841-845, Copyright © 1999 by International Epidemiological Association
J Sundquist, M Malmstrom and SE Johansson
BACKGROUND: This article examines whether the neighbourhood environment
influences intermediate cardiovascular disease (CVD) risk factors, such as
obesity (body mass index [BMI]), and lifestyle factors, such as no physical
activity and smoking, when adjusted for the individual socioeconomic status
(SES). METHODS: The study consists of face-to-face interviews from the
Swedish Annual Level of Living Survey (SALLS) matched with the social
status of the respondents' residential areas measured by two composite
indices, the Care Need Index (CNI) and the Townsend score. The response
rate was about 80%. This study was limited to the residents aged 25-74
years and consists of 9240 interviews from the years 1988-1989, when there
were extended items in the SALLS about health and lifestyle. The data were
analysed using a hierarchical logistic regression model. RESULTS: There was
a gradient within every SES group so that respondents with a low (or
intermediate or high) educational level exhibited an increasing proportion
of daily smokers, physically inactive people and obese individuals with
increasing neighbourhood deprivation. The multilevel model showed that
respondents living in the most deprived neighbourhoods had an increased
risk for being a daily smoker, engaging in no physical activity and being
obese when adjusted for the individual SES. CONCLUSIONS: We showed that the
area level has an important influence on risk factors for CVD which goes
beyond the individual educational attainment. An increased level of living
standard, more resources for primary health care and health promotion
targeting the community level should be beneficial.
ARTICLES
Cardiovascular risk factors and the neighbourhood environment: a multilevel analysis
Stanford Center for Research in Disease Prevention, Stanford University School of Medicine, Palo Alto, CA, USA. jan.sundquist@smi.mas.lu.se
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