Neighborhood socioeconomic deprivation and residential instability - Effects on incidence of ischemic heart disease and survival after myocardial infarction
Neighborhood socioeconomic deprivation and residential instability - Effects on incidence of ischemic heart disease and survival after myocardial infarction
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DOI：
10.1097/01.ede.0000249573.22856.9a
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发表时间：
2007-01-01
期刊：
影响因子：
5.4
通讯作者：
Merlo, Juan
中科院分区：
文献类型：
--
作者：
Chaix, Basile;Rosvall, Maria;Merlo, Juan
背景资料：以前的文献表明，邻里社会经济地位影响缺血性心脏病的风险，但很少有人知道的机制联系的居住环境缺血性心脏病的发病率和死亡率。我们研究了社区社会经济地位和社区居住稳定性（作为社会互动模式的决定因素）是否对缺血性心脏病风险有影响。此外，我们还调查了不同的背景影响是否在疾病过程的不同阶段起作用，即对急性心肌梗死（MI）后的发病率、1天病死率和长期生存率的影响。（基准线：1996年1月1日）在瑞典斯堪尼亚地区定义，我们估计了调整个体社会人口因素和既往疾病的多水平生存模型。调整后，多水平生存模型表明缺血性心脏病的发病率随着社区社会经济贫困而增加，但与社区居住不稳定性仅弱相关（对于高与低居住不稳定性，风险比= 1.2; 95%可信区间= t.0-1.4）。相反，除了个人和背景社会经济环境以及到医院的距离的影响外，我们看到了明显更高的I日病死率（4.9; 1.8-15）和MI后28天仍存活的个体中MI后存活时间较短（4.3; 1.2-17）在居住不稳定性高与低的社区中。在居住不稳定的社区，社会支持的可用性较低，这可能是介导的住宅不稳定对心肌梗死后生存的影响，这表明了一类新的中间过程，应考虑到在调查缺血性心脏病的背景影响。此外，不同的背景效应可能在疾病过程的不同阶段起作用（即，对MI后的发病率、病死率和存活率）。
Background: Previous literature has shown that neighborhood socioeconomic position influences the risk of ischemic heart disease, but little is known about the mechanisms linking the residential context to ischemic heart disease incidence and mortality. We examined whether neighborhood socioeconomic position and neighborhood residential stability (as a determinant of social interaction patterns) have an influence on ischemic heart disease risk. Moreover, we investigated whether dissimilar contextual influences operate at different stages of the disease process, ie, on incidence, 1-day case-fatality, and long-term survival after acute myocardial infarction (MI).Methods: Using a large 27-year longitudinal cohort (baseline: 1 January 1996) defined in the Scania region, Sweden, we estimated multilevel survival models adjusted for individual sociodemographic factors and previous diseases of the persons.Results: After adjustment, multilevel survival models indicated that the incidence of ischemic heart disease increased with neighborhood socioeconomic deprivation but was only weakly associated with neighborhood residential instability (for high vs low residential instability, hazard ratio = 1.2; 95% credible interval = t.0-1.4). Conversely, beyond effects of individual and contextual socioeconomic circumstances and distance to the hospital, we saw a markedly higher I-day case-fatality (4.9; 1.8-15) and shorter survival time after MI among individuals still alive 28 days after MI (4.3; 1.2-17) in neighborhoods with a high versus low residential instability.Conclusions: Effects of residential instability on post-MI survival may be mediated by the lower availability of social support in residentially unstable neighborhoods, suggesting a new class of intermediate processes that should be taken into account when investigating contextual influences on ischemic heart disease. Moreover, dissimilar contextual effects may operate at various stages of the disease process (ie, on incidence, case-fatality, and survival after MI).