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Associations of chronic individual-level and neighbourhood-level stressors with incident coronary heart disease: the Multi-Ethnic Study of Atherosclerosis
  1. Kiarri N Kershaw1,
  2. Ana V Diez Roux2,
  3. Alain Bertoni3,
  4. Mercedes R Carnethon1,
  5. Susan A Everson-Rose4,
  6. Kiang Liu1
  1. 1Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
  2. 2Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
  3. 3Division of Public Health Sciences, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
  4. 4Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, Minnesota, USA
  1. Correspondence to Dr Kiarri Kershaw, Department of Preventive Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL 60611, USA; k-kershaw{at}


Background Several individual-level stressors have been linked to incident coronary heart disease (CHD), but less attention has focused on the influence of neighbourhood-level sources of stress. In this study we examined prospective associations of individual-level and neighbourhood-level stressors with incident CHD.

Methods Multi-Ethnic Study of Atherosclerosis participants aged 45–84 years at baseline (2000–2002) with complete data were included in the analyses (n=6678 for individual-level and n=6105 for neighbourhood-level stressors). CHD was defined as non-fatal myocardial infarction, resuscitated cardiac arrest or CHD death. Median follow-up was 10.2 years. Multivariable Cox proportional hazards models were fitted to estimate associations of individual-level and neighbourhood-level stressors (categorised into approximate tertiles) with incident CHD.

Results Higher reported individual-level stressors were associated with higher incident CHD. Participants in the high individual-level stressor category had 65% higher risk of incident CHD (95% CI 1.23 to 2.22) than those in the low category after adjusting for sociodemographics (P for trend=0.002). This association weakened but remained significant with further adjustment for behavioural and biological risk factors. There was a non-linear relationship between neighbourhood-level stressors and incident CHD (P for quadratic term=0.01). Participants in the medium category had 49% higher CHD risk (95% CI 1.06 to 2.10) compared with those in the low category; those in the high category had only 27% higher CHD risk (95% CI 0.83 to 1.95). These associations persisted with adjustment for risk factors and individual-level stressors.

Conclusions Individual-level and neighbourhood-level stressors were independently associated with incident CHD, though the nature of the relationships differed.

  • Neighborhood/place

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