title: Associations of chronic individual-level and neighbourhood-level stressors with incident coronary heart disease: the Multi-Ethnic Study of Atherosclerosis.
abstract: BACKGROUND
  Several individual-level stressors have been linked to incident coronary heart disease (CHD), but less attention has focused on the influence of neighbourhood-level sources of stress. In this study we examined prospective associations of individual-level and neighbourhood-level stressors with incident CHD.
  
  
  METHODS
  Multi-Ethnic Study of Atherosclerosis participants aged 45-84 years at baseline (2000-2002) with complete data were included in the analyses (n=6678 for individual-level and n=6105 for neighbourhood-level stressors). CHD was defined as non-fatal myocardial infarction, resuscitated cardiac arrest or CHD death. Median follow-up was 10.2 years. Multivariable Cox proportional hazards models were fitted to estimate associations of individual-level and neighbourhood-level stressors (categorised into approximate tertiles) with incident CHD.
  
  
  RESULTS
  Higher reported individual-level stressors were associated with higher incident CHD. Participants in the high individual-level stressor category had 65% higher risk of incident CHD (95% CI 1.23 to 2.22) than those in the low category after adjusting for sociodemographics (P for trend=0.002). This association weakened but remained significant with further adjustment for behavioural and biological risk factors. There was a non-linear relationship between neighbourhood-level stressors and incident CHD (P for quadratic term=0.01). Participants in the medium category had 49% higher CHD risk (95% CI 1.06 to 2.10) compared with those in the low category; those in the high category had only 27% higher CHD risk (95% CI 0.83 to 1.95). These associations persisted with adjustment for risk factors and individual-level stressors.
  
  
  CONCLUSIONS
  Individual-level and neighbourhood-level stressors were independently associated with incident CHD, though the nature of the relationships differed.
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
authors.forename: Kiarri N
authors.initials: KN
authors.lastname: Kershaw
authors.affiliation: Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA.
authors.forename: Ana V
authors.initials: AV
authors.lastname: Diez Roux
authors.affiliation: Division of Public Health Sciences, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA.
authors.forename: Alain
authors.initials: A
authors.lastname: Bertoni
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
authors.forename: Mercedes R
authors.initials: MR
authors.lastname: Carnethon
authors.affiliation: Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Everson-Rose
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
authors.forename: Kiang
authors.initials: K
authors.lastname: Liu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003327:Coronary Disease / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012307:Risk Factors; D012449:Safety; D012931:Social Environment; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000150:complications / Q000503:physiopathology*; D014481:United States / Q000453:epidemiology
keywords: CORONARY HEART DISEASE; Neighborhood/place; STRESS