IJE Advance Access originally published online on May 20, 2004
International Journal of Epidemiology 2004 33(4):732-741; doi:10.1093/ije/dyh087
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IJE vol.33 no.4 © International Epidemiological Association 2004; all rights reserved.
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Contextual effects of social fragmentation and material deprivation on risk of myocardial infarction—results from the Stockholm Heart Epidemiology Program (SHEEP)
1 Karolinska Institute, Centre for Health Equity Studies (CHESS)
2 Departments of Epidemiology and 3 Social Medicine, Stockholm County Council, Stockholm, Sweden
Correspondence: Maria Kölegård Stjärne, CHESS—Centre for Health Equity Studies, Stockholms Universitet/Karolinska Institutet, SE 106 91 Stockholm, Sweden. E-mail: maria.k.stjarne{at}chess.su.se, www.chess.su.se
Background Socioeconomic deprivation has been suggested as a contextual feature of importance for cardiovascular disease and mortality, whereas the effect of social fragmentation has largely been studied in relation to suicide. In this study we examine the contextual effects of social fragmentation and material deprivation on the incidence of myocardial infarction (MI).
Methods A population-based case-control study (SHEEP). The study base included all Swedish citizens aged 45–70 living in the Stockholm metropolitan area. Cases (n = 1631) were all first events of MI during 1992–1994. Exposure information on individual risk factors was obtained from a questionnaire. Areas (n = 862) were classified according to the Townsend index, measuring material deprivation, and the Congdon index, measuring social fragmentation.
Results We found increased incidence of MI in both materially deprived and socially fragmented contexts that were not due to confounding from individual social risk factors being more prevalent among subjects in deprived settings. The adjusted relative risk of MI was 2.0 (95% CI: 1.3, 3.1) for women living in the top quartile of materially deprived areas. For men, the adjusted relative risk (RR) was 1.6 (95% CI: 1.2, 2.1).Women living in the top quartile of socially fragmented areas had an RR of MI of 1.6 (95% CI: 1.0, 2.5) after adjustment, while the corresponding figure for men was 1.4 (95% CI: 1.0, 1.8).
Conclusion Our findings support the notion that the social context in which people live has an impact on the risk of coronary heart disease. We could not determine which of the contextual aspects under study made the most substantial contribution. Mutual adjustment of the two indices suggests that material deprivation is the dominating factor, especially for women. However, the indices were highly correlated (r = 0.87), and it cannot be ruled out that they partly measure the same underlying phenomenon.
Keywords Material deprivation, myocardial infarction, social context, social fragmentation, social position
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