Neighborhood of residence and incidence of coronary heart disease.

Background: Where a person lives is not usually thought of as an independen t predictor of his or her health, although physical and social features of places of residence may affect health and health-related behavior. Methods: Using data from the Atherosclerosis Risk in Communities Study, we examined the relation between characteristics of neighborhoods and the inci dence of coronary heart disease. Participants were 45 to 64 years of age at base line and were sampled from four study sites in the United States: For syth County, North Carolina; Jackson, Mississippi; the northwestern suburbs of Minneapolis; and Washington County, Maryland. As proxies for neighborho ods, we used block groups containing an average of 1000 people, as defined by the U.S. Census. We constructed a summary score for the socioeconomic en vironment of each neighborhood that included information about wealth and i ncome, education, and occupation. Results: During a median of 9.1 years of follow-up, 615 coronary events occ urred in 13,009 participants. Residents of disadvantaged neighborhoods (tho se with lower summary scores) had a higher risk of disease than residents o f advantaged neighborhoods, even after we controlled for personal income, e ducation, and occupation. Hazard ratios for coronary heart disease among lo w-income persons living in the most disadvantaged neighborhoods, as compare d with high-income persons in the most advantaged neighborhoods, were 3.1 a mong whites (95 percent confidence interval, 2.1 to 4.8) and 2.5 among blac ks (95 percent confidence interval, 1.4 to 4.5). These associations remaine d unchanged after adjustment for established risk factors for coronary hear t disease. Conclusions: Even after controlling for personal income, education, and occ upation, we found that living in a disadvantaged neighborhood is associated with an increased incidence of coronary heart disease. (N Engl J Med 2001; 345:99-106.) Copyright (C) 2001 Massachusetts Medical Society.