Neighborhoods and CVD Risk in a Multiethnic Cohort (RMI)

描述(申请人提供)：最近的流行病学研究发现，即使在控制了个人收入、教育和职业的指标后，生活在社会经济条件较差的社区也与冠心病的患病率和发病率增加有关。虽然这表明邻居的特征可能与心血管风险相关，但重要的问题仍然是所观察到的关联是否反映了因果过程。两个重要的悬而未决的问题是选择因素在产生这些关联中的作用，以及需要确定相关社区的具体特征。这项流行病学研究的总体目的是调查社区特征是否与多民族队列中的疾病风险有关。利用可公开获得的和新收集的与动脉粥样硬化多种族研究(MESA)相关的邻里数据，该项目将：(1)检查邻里社会经济特征与亚临床动脉粥样硬化的流行和进展之间的关系；(2)检查邻里社会经济特征与可能调节邻里疾病风险差异的特定个人水平因素的关联；(3)开发邻里环境特定特征的测量(如资源可获得性、邻里社会凝聚力和邻里压力)，并检查它们与选定的个体水平风险因素的关系；(4)确定这些特定邻里特征是否解释了社会经济优势社区和社会经济劣势社区之间心血管风险的差异；以及(5)检查社区特征是否对心血管风险的种族/民族差异有贡献。对社区属性的衡量将以2000年人口普查数据、地区居民调查和使用地理信息系统方法将地区资源数据与台地社区联系起来为基础。对亚临床疾病的检查结果避免了根据健康状况选择社区成员的相关问题。该项目将使用两种创新的方法(居住调查和生态测量技术以及基于地理信息系统的方法)来开发特定社区属性的直接测量，以测试它们与疾病风险的关系。确认社区的特定特征与疾病有因果关系将对预防具有重要意义。

DESCRIPTION (provided by applicant): Recent epidemiologic studies have found that living in socioeconomically disadvantaged neighborhoods is associated with increased prevalence and incidence of coronary heart disease, even after controlling for measures of personal income, education, and occupation. Although this suggests that features of neighborhoods may be relevant to cardiovascular risk, important questions remain regarding whether the associations observed reflect causal processes. Two important unresolved issues are the role of selection factors in generating these associations and the need to identify the specific characteristics of neighborhoods that are relevant. The general aim of this epidemiologic study is to investigate if neighborhood characteristics are related to disease risk in a multiethnic cohort. Using publicly available and newly collected neighborhood data linked to the Multi-Ethnic Study of Atherosclerosis (MESA) the project will: (1) examine the relationship between neighborhood socioeconomic characteristics and the prevalence and progression of subclinical atherosclerosis; (2) examine associations of neighborhood socioeconomic characteristics with specific individual-level factors which may mediate neighborhood differences in disease risk; (3) develop measures of specific characteristics of neighborhood environments (such as measures of resource availability, neighborhood social cohesion and neighborhood stress) and examine their relation to selected individual-level risk factors; (4) determine if these specific neighborhood characteristics explain differences in cardiovascular risk between socioeconomically advantaged and socioeconomically disadvantaged neighborhoods; and (5) examine if neighborhood characteristics contribute to race/ethnic differences in cardiovascular risk. Measures of neighborhood attributes will be based on Year 2000 Census data, surveys of area residents, and the use of GIS methods to link data on area resources to MESA neighborhoods. The examination of subclinical disease as outcomes avoids problems related to selection of persons into neighborhoods based on their health status. The project will use two innovative approaches (residential surveys and ecometric techniques and GIS-based methods) to develop direct measures of specific neighborhood attributes in order to test their relationship to disease risk. Confirming that specific features of neighborhoods are causally related to disease would have important implications for prevention.