Cardiovascular risk factors and the neighbourhood environment: a multilevel analysis

Background This article examines whether the neighbourhood environment infl uences intermediate cardiovascular disease (CVD) risk factors, such as obes ity (body mass index [BMI]), and lifestyle factors, such as no physical act ivity and smoking, when adjusted for the individual socioeconomic status (S ES). Methods The study consists of fate-to-face interviews from the Swedish Annu al Level of Living Survey (SALLS) matched with the social status of the res pondents' residential areas measured by two composite indices, the Care Nee d 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 i nterviews from the years 1988-1989, when there were extended items in the S ALLS about health and lifestyle. The data were analysed using a hierarchica l logistic regression model. Results There was a gradient within every SES group so that respondents wit h a low (or intermediate or high) educational level exhibited an increasing proportion of daily smokers, physically inactive people and obese individu als with increasing neighbourhood deprivation. The multilevel model showed that respondents living in the most deprived neighbourhoods had an increase d 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 ris k factors for CVD which goes beyond the individual educational attainment. An increased level of living standard, more resources for primary health ca re and health promotion targeting the community level should be beneficial.