Exposure to New York City as a risk factor for heart attack mortality

Objective: If New York City (NYC) residents' unusually high rate of ischemi c heart disease (IIID) results from chronic exposure to that city, there mi ght also be an effect of acute exposure among visitors to NYC. We explored this possibility and also whether IHD is reduced among NYC residents dying away from the city. Methods: Using all US death certificates fur 1985-1994, we examined (correcting for age, race, and sex) IHD deaths in three groups : NYC residents who died in the city. non-NYC residents visiting the city, and NYC residents traveling out of the city. Results: IHD deaths among NYC residents dying in the city were 155% of the expected proportion (p < .0001 ). Among visitors to the city. such deaths were 134% of the expected propor tion (p < .0001). The proportion of IHD deaths among NYC residents dying ou t of the city was only 80% of the expected value (p < .0001). These effects are not due to nearby commuters, recent immigrants, local classification p ractices. or socioeconomic status. and they do not appear in other US citie s. Conclusions: With both chronic and acute effects of exposure to NYC, the se data are consistent with the hypothesis that the stress of NYC is linked to the high rate of IHD.