NEIGHBORHOOD ENVIRONMENTS AND CORONARY HEART-DISEASE - A MULTILEVEL ANALYSIS

The authors investigated whether neighborhood socioeconomic characteri stics are associated with coronary heart disease prevalence and risk f actors, whether these associations persist after adjustment for indivi dual-level social class indicators, and whether the effects of individ ual-level indicators vary across neighborhoods. The study sample consi sted of 12,601 persons in four US communities (Washington County, Mary land; Forsyth County, North Carolina; Minneapolis, Minnesota; and Jack son, Mississippi) participating in the baseline examination of the Ath erosclerosis Risk in Communities Study (1987-1989). Neighborhood chara cteristics were obtained from 1990 US Census block-group measures. Mul tilevel models were used to estimate associations with neighborhood va riables after adjustment for individual-level indicators of social cla ss. Living in deprived neighborhoods was associated with increased pre valence of coronary heart disease and increased levels of risk factors , with associations generally persisting after adjustment for individu al-level variables. Inconsistent associations were documented for seru m cholesterol and disease prevalence in African-American men. For Jack son African-American men living in poor neighborhoods, coronary heart disease prevalence decreased as neighborhood characteristics worsened. Additionally, in African-American men from Jackson, low social class was associated with increased serum cholesterol in ''richer'' neighbor hoods but decreased serum cholesterol in ''poorer'' neighborhoods. Nei ghborhood environments may be one of the pathways through which social structure shapes coronary heart disease risk.