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Health-promoting and health-damaging neighbourhood resources and coronary heart disease: a follow-up study of 2 165 000 people
  1. Naomi Kawakami1,2,
  2. Xinjun Li1,
  3. Kristina Sundquist1
  1. 1Center for Primary Health Care Research, Lund University, Malmö, Sweden
  2. 2Center for Family and Community Medicine, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Dr Kristina Sundquist, Center for Primary Health Care Research, Lund University, CRC, Building 28, Floor 11, Entrance 72, Malmö University Hospital, S-205 02 Malmö, Sweden; kristina.sundquist{at}


Background It has been hypothesised that the presence of health-damaging factors and lack of health-promoting factors lie in the causal pathway between neighbourhood deprivation and coronary heart disease (CHD). This study is the first to examine the associations between individual-level CHD risk and neighbourhood availability of fast-food restaurants, bars/pubs, physical activity facilities and healthcare resources.

Methods Multilevel logistic regression models were used for the follow-up of 1 065 000 men and 1 100 000 women (aged 35–80 years) between 1 December 2005 and 31 December 2007, for individual-level CHD events (both morbidity and mortality).

Results The relatively weak associations between neighbourhood availability of potentially health-damaging and health-promoting goods, services and resources, and CHD incidence no longer remained significant after adjustment for neighbourhood-level deprivation and individual-level age and income.

Conclusions The presence of potentially health-damaging factors and lack of potentially health-promoting factors do not seem to contribute significantly to the development of CHD. Other features of deprived neighbourhoods appear to play a greater role.

  • Multilevel modelling
  • small-area epidemiology
  • social deprivation

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  • Funding This work was supported by grants from the Swedish Research Council (K2005-27X-15428-01A, 2008-3110 and 2008-2638), the Swedish Council for Working Life and Social Research (2006-0386, 2007-1754 and 2007-1962) and Formas, the Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning (2006-4255-6596-99 and 2007-1352).

  • Competing interests None.

  • Ethics approval Ethics approval was provided by Lund University.

  • Provenance and peer review Not commissioned; externally peer reviewed.