Background Studies have shown associations between area or neighbourhood-level deprivation and cardiovascular disease (CVD) risk in middle age. However, there is little evidence on the longitudinal influence of neighbourhood-level socio-economic factors on CVD risk in older age. Therefore, we aimed to investigate the prospective association between neighbourhood level socio-economic deprivation and CVD mortality, and to assess the role of individual socio-economic position and established cardiovascular risk factors underlying these associations.
Methods The investigation is based on a cohort of 3648 men, aged 60–79 years in 1998–2000, drawn from 24 British towns and followed-up for CVD (myocardial infarction and stroke) mortality over 12 years. Neighbourhood deprivation was based on the national Index of Multiple Deprivation (IMD), a composite score based on neighbourhood-level factors including income, employment, housing and access to services. IMD scores for Scotland and Wales were adjusted to that of England using the income and employment scores which are comparable in the IMD scores for England, Scotland and Wales. Quintiles based on the overall IMD score were created (quintile 1 being least deprived). Individual socio-economic position was based on longest-held occupational social class. Multilevel discrete-time models were applied using logistic regression to obtain odds ratios according to IMD quintiles for CVD mortality over the 12 year follow-up by dividing survival time in discrete time periods of 1 month.
Results Over the 12 year follow-up 516 CVD deaths occurred. The relative risk of CVD mortality showed a graded increase from IMD quintile 1 to 5. Compared to quintile 1, the age-adjusted odds of CVD mortality in quintile 5 was 1.75 (95% CI 1.31–2.34), and 1.69 (95% CI 1.24–2.30) on further adjustment for individual social class. These estimates attenuated slightly, but remained significant on adjustment for smoking, body mass index (BMI), physical activity and alcohol (odds ratio for quintile 5 was 1.50; 95% CI 1.10, 2.05). Further adjustment for blood pressure and lipids made little difference.
Conclusion Neighbourhood-level deprivation is associated with an increased risk of CVD mortality in older people independent of individual-level social class. Individual-level behavioural risk factors (smoking, BMI and physical activity) contribute to this association to some extent. The role of neighbourhood-level factors (such as access to health services, air pollution) merits further research.
- neighbourhood deprivation
- cardiovascular mortality
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