title: Associations between area-level unemployment, body mass index, and risk factors for cardiovascular disease in an urban area.
abstract: Cardiovascular Disease (CVD) has been linked to "neighbourhood" socioeconomic status (nSES), often operationalized as a composite index of aggregate income, occupation and education within predefined administrative boundaries. The role of specific, non-composite socioeconomic markers has not been clearly explained. It is also unclear whether the relationship between nSES and CVD varies according to sex. We sought to determine whether area-level unemployment (ALU) was associated with CVD risk, and whether this association differed by sex.
  
  
  
  342 individuals from the Montreal Neighbourhood Survey of Lifestyle and Health provided self-reported behavioural and socioeconomic information. A nurse collected biochemical and anthropometric data. ALU, a weighted average of the proportion of persons 15-years and older available for but without work, was measured using a Geographic Information System for a 250 m buffer centred on individual residence. Generalized Estimating Equations were used to estimate the associations between ALU, body mass index (BMI) and a cumulative score for total cardiometabolic risk (TCR).
  
  
  
  After confounder adjustments, the mean 4(th) minus 1(st) quartile difference in BMI was 3.19 kg/m(2) (95% CI: 2.39, 3.99), while the prevalence ratio for the 4(th) relative to 1(st) quartile for TCR was 2.20 (95 % CI: 1.53, 3.17). Sex interacted with ALU; women relative to men had greater mean 3.97 kg/m(2) (95% CI: 2.08, 5.85) BMI and greater mean TCR 1.51 (95% CI: 0.78, 2.90), contrasted at mean ALU.
  
  
  
  Area-level unemployment is associated with greater CVD risk, and this association is stronger for women.
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. ashley.naimi@unc.edu
authors.forename: Ashley Isaac
authors.initials: AI
authors.lastname: Naimi
authors.forename: Catherine
authors.initials: C
authors.lastname: Paquet
authors.forename: Lise
authors.initials: L
authors.lastname: Gauvin
authors.forename: Mark
authors.initials: M
authors.lastname: Daniel
mesh_terms: D000328:Adult; D001786:Blood Glucose; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D016001:Confidence Intervals; D005260:Female; D040362:Geographic Information Systems; D015438:Health Behavior; D006306:Health Surveys; D006801:Humans; D008019:Life Style; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011792:Quebec / Q000453:epidemiology; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D014478:Unemployment / Q000706:statistics & numerical data*; D014505:Urban Population / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D008055:Lipids