title: Neighbourhood environment and stroke: a follow-up study in Sweden.
abstract: BACKGROUND
  In recent years, research on the association between physical environments and cardiovascular disease outcomes has gained momentum with growing attention being paid to Geographic Information Systems (GIS). This nationwide study is the first to examine the effect of neighbourhood physical environments on individual-level stroke, using GIS-based measures of neighbourhood availability of potentially health-damaging (fast food restaurants and pubs/bars) and health-promoting (physical activity and healthcare) resources.
  
  
  METHODS
  The study population comprised a nationwide sample of 2,115,974 men and 2,193,700 women aged 35-80 years who were followed between 1 December 2005 and 31 December 2007 in Sweden. Totally 42,270 first-ever strokes (both morbidity and mortality) were identified. Multilevel logistic regression models were used to estimate the association between neighbourhood availability of four different resources (fast food restaurants, pubs/bars, physical activity and healthcare) and individual-level stroke.
  
  
  RESULTS
  There were significant associations between neighbourhood availability of the four types of neighbourhood resources and individual-level stroke. The significant odds ratios varied between 1.06 and 1.12 for men and 1.07 and 1.24 for women. After adjustment for age, income, and neighbourhood-level deprivation, the increased odds remained statistically significant for neighbourhood availability of fast food restaurants in both men and women.
  
  
  CONCLUSIONS
  Specific neighbourhood availability of resources were associated with individual-level stroke but most of these associations were explained by individual-level sociodemographic factors and neighbourhood-level deprivation.
authors: Center for Community-based Health Research and Education, Organization for the Promotion of Project Research, Shimane University, Izumo, Japan. thamano@med.shimane-u.ac.jp
authors: Tsuyoshi
authors: T
authors: Hamano
authors: Naomi
authors: N
authors: Kawakami
authors: Xinjun
authors: X
authors: Li
authors: Kristina
authors: K
authors: Sundquist
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D004777:Environment; D005260:Female; D005500:Follow-Up Studies; D005502:Food; D006293:Health Promotion / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D020521:Stroke / Q000453:epidemiology*; D013548:Sweden / Q000453:epidemiology