Neighborhood socioeconomic status and coronary heart disease risk prediction in a nationally representative sample.
OBJECTIVE
Test the association between coronary heart disease (CHD) risk scores and neighborhood socioeconomic status (NSES) in a US nationally-representative sample and describe whether the association varies by gender and race/ethnicity.


METHODS
Cross-sectional study.


METHODS
We use Health and Nutrition Examination Survey (NHANES) data from 1999 to 2004 linked with Census tract data. Multivariable regression models and propensity score adjusted models are employed to test the association between NSES and 10-year risk of CHD based on the Framingham Risk Score (FRS), adjusting for individual-level characteristics.


RESULTS
An individual living in a neighborhood at the 75th percentile of NSES (high NSES) has, on average, a 10-year CHD risk that is 0.16 percentage points lower (95% Confidence Interval 0.16, 0.17) than a similar person residing in a neighborhood at the 25th percentile of NSES (low NSES). Race/ethnicity and gender were found to significantly modify the association between NSES and CHD risk: the association is larger in men than women and in whites than minorities. Propensity score models showed that findings on the main effects of NSES were robust to self-selection into neighborhoods. Similar results were observed between NSES and risk of cardiovascular disease events.


CONCLUSIONS
NSES is significantly associated with CHD risk, and the relationship varies by gender and race/ethnicity.
Johns Hopkins School of Medicine, Division of General Internal Medicine, Baltimore, MD 21287, USA. cpollac2@jhmi.edu
C E
CE
Pollack
M E
ME
Slaughter
B A
BA
Griffin
T
T
Dubowitz
C E
CE
Bird
D001741:Black or African American / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000208:ethnology*; D003430:Cross-Sectional Studies; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012307:Risk Factors; D017678:Sex Distribution; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*