03027nas a2200361 4500008004100000022001400041245011300055210006900168260001300237300001100250490000700261520198700268653002202255653000902277653002802286653004002314653001102354653002202365653001102387653001102398653000902409653001802418653003002436653001702466653002602483653001802509100002202527700002202549700001502571700002302586700002102609856003502630 2004 eng d a0143-005X00aNeighbourhood environments and mortality in an elderly cohort: results from the cardiovascular health study.0 aNeighbourhood environments and mortality in an elderly cohort re c2004 Nov a917-230 v583 a

BACKGROUND: It has been postulated that neighbourhood conditions are related to the health of the elderly population but longitudinal studies are rare and confounding by individual level variables remains a possibility.

METHODS: Data were obtained from the cardiovascular health study, a population based study of adults aged 65 years and older. Census block groups were used as proxies for neighbourhoods. A summary score was used to characterise the neighbourhood socioeconomic environment. Information on personal socioeconomic indicators, cardiovascular disease prevalence, and cardiovascular risk factors was obtained from the baseline examination. Proportional hazards regression and propensity score matching were used to control for individual level variables.

RESULTS: Over the eight year follow up there were 1346 deaths among the 5074 participants, of which 43% were attributable to cardiovascular disease. Among white participants, living in the most disadvantaged neighbourhood group was associated with higher rates of cardiovascular death, after adjustment for income, education, and occupation (hazard ratio (HR) 1.5, 95% confidence intervals (CI) 1.2 to 1.9). No neighbourhood differences were observed for non-cardiovascular deaths. Estimates for black participants were 1.3 (95% CI 0.7 to 2.3) for cardiovascular deaths and 1.4 (95% CI 0.8 to 2.4) for non-cardiovascular deaths, but sample size was small. In white participants, associations of neighbourhood characteristics with cardiovascular mortality persisted after adjustment for prevalent baseline disease and cardiovascular risk factors. The use of propensity score matching led to similar results (HR for the lowest compared with the highest neighbourhood score group: 1.6 95% CI 1.1 to 2.5, controlling for personal socioeconomic indicators).

CONCLUSION: Neighbourhood disadvantage is related to rates of cardiovascular death in elderly white adults.

10aAfrican Americans10aAged10aCardiovascular Diseases10aEuropean Continental Ancestry Group10aFemale10aFollow-Up Studies10aHumans10aIncome10aMale10aPoverty Areas10aResidence Characteristics10aRisk Factors10aSocioeconomic Factors10aUnited States1 aRoux, Ana, V Diez1 aBorrell, Luisa, N1 aHaan, Mary1 aJackson, Sharon, A1 aSchultz, Richard uhttps://chs-nhlbi.org/node/809