Neighborhoods and CVD Risk in a Multiethnic Cohort

描述（由申请人提供）：最近的流行病学研究发现，即使在控制了个人收入、教育和职业的措施后，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。虽然这表明社区特征可能与心血管风险有关，但重要的问题仍然是观察到的关联是否反映了因果关系。两个重要的未解决的问题是选择因素在产生这些联系中的作用，以及确定相关社区的具体特征的必要性。本流行病学研究的总体目的是调查多民族队列中邻里特征是否与疾病风险相关。利用与多种族动脉粥样硬化研究（MESA）相关的公开可用和新收集的社区数据，该项目将：(1)检查社区社会经济特征与亚临床动脉粥样硬化的患病率和进展之间的关系；(2)研究社区社会经济特征与可能介导社区疾病风险差异的特定个体水平因素的关联；(3)制定社区环境具体特征的测量方法（如资源可用性、社区社会凝聚力和社区压力的测量方法），并研究它们与选定的个人层面风险因素的关系；(4)确定这些特定的社区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；(5)研究社区特征是否对心血管风险的种族/民族差异有影响。社区属性的测量将基于2000年人口普查数据、对地区居民的调查，以及使用GIS方法将地区资源数据与MESA社区联系起来。将亚临床疾病作为结果的检查避免了根据健康状况选择人群进入社区的问题。该项目将采用两种创新方法（住宅调查和生态计量技术以及基于地理信息系统的方法）来制定具体社区属性的直接措施，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.