The influence of neighbourhood-level socioeconomic deprivation on cardiovascular disease mortality in older age: longitudinal multilevel analyses from a cohort of older British men.

Abstract

BACKGROUND:

Evidence from longitudinal studies on the influence of neighbourhood socioeconomic factors in older age on cardiovascular disease (CVD) mortality is limited. We aimed to investigate the prospective association of neighbourhood-level deprivation in later life with CVD mortality, and assess the underlying role of established cardiovascular risk factors.

METHODS:

A socially representative cohort of 3924 men, aged 60-79 years in 1998-2000, from 24 British towns, was followed up until 2012 for CVD mortality. Quintiles of the national Index of Multiple Deprivation (IMD), a composite score of neighbourhood-level factors (including income, employment, education, housing and living environment) were used. Multilevel logistic regression with discrete-time models (stratifying follow-up time into months) were used.

RESULTS:

Over 12 years, 1545 deaths occurred, including 580 from CVD. The risk of CVD mortality showed a graded increase from IMD quintile 1 (least deprived) to 5 (most deprived). Compared to quintile 1, the age-adjusted odds of CVD mortality in quintile 5 were 1.71 (95% CI 1.32 to 2.21), and 1.62 (95% CI 1.23 to 2.13) on further adjustment for individual social class, which was attenuated slightly to 1.44 (95% CI 1.09 to 1.89), but remained statistically significant after adjustment for smoking, body mass index, physical activity and use of alcohol. Further adjustment for blood pressure, high-density lipoprotein cholesterol and prevalent diabetes made little difference.

CONCLUSIONS:

Neighbourhood-level deprivation was associated with an increased risk of CVD mortality in older people independent of individual-level social class and cardiovascular risk factors. The role of other specific neighbourhood-level factors merits further research.

• Authors: S E Ramsay, R W Morris, P H Whincup, S V Subramanian, A O Papacosta, Lucy T Lennon, S G Wannamethee
• Journal: Journal of epidemiology and community health (J Epidemiol Community Health) Vol. 69 Issue 12 Pg. 1224-31 (Dec 2015) ISSN: 1470-2738 [Electronic] England
• PMID: 26285580 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Topics

• Aged
• Cardiovascular Diseases (economics, mortality)
• Cause of Death
• Employment (classification, economics)
• Humans
• Logistic Models
• Longitudinal Studies
• Male
• Middle Aged
• Multilevel Analysis
• Poverty Areas
• Prospective Studies
• Residence Characteristics (classification)
• Risk Factors
• Social Class
• United Kingdom (epidemiology)