title: Exposure to New York City as a risk factor for heart attack mortality.
abstract: OBJECTIVE
  If New York City (NYC) residents' unusually high rate of ischemic heart disease (IHD) results from chronic exposure to that city, there might also be an effect of acute exposure among visitors to NYC. We explored this possibility and also whether IHD is reduced among NYC residents dying away from the city.
  
  
  METHODS
  Using all US death certificates for 1985-1994, we examined (correcting for age, race, and sex) IHD deaths in three groups: NYC residents who died in the city, non-NYC residents visiting the city, and NYC residents traveling out of the city.
  
  
  RESULTS
  IHD deaths among NYC residents dying in the city were 155% of the expected proportion (p < .0001). Among visitors to the city, such deaths were 134% of the expected proportion (p < .0001). The proportion of IHD deaths among NYC residents dying out of the city was only 80% of the expected value (p <.0001). These effects are not due to nearby commuters, recent immigrants, local classification practices, or socioeconomic status, and they do not appear in other US cities.
  
  
  CONCLUSIONS
  With both chronic and acute effects of exposure to NYC, these data are consistent with the hypothesis that the stress of NYC is linked to the high rate of IHD.
authors.affiliation: University of California, San Diego, La Jolla 92093-0109, USA. nicko@ucsd.edu
authors.forename: N
authors.initials: N
authors.lastname: Christenfeld
authors.forename: L M
authors.initials: LM
authors.lastname: Glynn
authors.forename: D P
authors.initials: DP
authors.lastname: Phillips
authors.forename: I
authors.initials: I
authors.lastname: Shrira
mesh_terms: D004781:Environmental Exposure / Q000009:adverse effects*; D016021:Epidemiologic Studies; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology* / Q000401:mortality*; D017202:Myocardial Ischemia / Q000209:etiology / Q000401:mortality; D009519:New York City / Q000453:epidemiology; D012307:Risk Factors; D013312:Stress, Physiological / Q000150:complications*; D013315:Stress, Psychological / Q000150:complications*; D014195:Travel; D014481:United States / Q000453:epidemiology; D014504:Urban Health / Q000706:statistics & numerical data*