title: Neighborhood-level racial/ethnic residential segregation and incident cardiovascular disease: the multi-ethnic study of atherosclerosis.
abstract: BACKGROUND
  Previous research suggests that neighborhood-level racial/ethnic residential segregation is linked to health, but it has not been studied prospectively in relation to cardiovascular disease (CVD).
  
  
  RESULTS
  Participants were 1595 non-Hispanic black, 2345 non-Hispanic white, and 1289 Hispanic adults from the Multi-Ethnic Study of Atherosclerosis free of CVD at baseline (aged 45-84 years). Own-group racial/ethnic residential segregation was assessed by using the Gi* statistic, a measure of how the neighborhood racial/ethnic composition deviates from surrounding counties' racial/ethnic composition. Multivariable Cox proportional hazards modeling was used to estimate hazard ratios for incident CVD (first definite angina, probable angina followed by revascularization, myocardial infarction, resuscitated cardiac arrest, coronary heart disease death, stroke, or stroke death) over 10.2 median years of follow-up. Among blacks, each standard deviation increase in black segregation was associated with a 12% higher hazard of developing CVD after adjusting for demographics (95% confidence interval, 1.02-1.22). This association persisted after adjustment for neighborhood-level characteristics, individual socioeconomic position, and CVD risk factors (hazard ratio, 1.12; 95% confidence interval, 1.02-1.23). For whites, higher white segregation was associated with lower CVD risk after adjusting for demographics (hazard ratio, 0.88; 95% confidence interval, 0.81-0.96), but not after further adjustment for neighborhood characteristics. Segregation was not associated with CVD risk among Hispanics. Similar results were obtained after adjusting for time-varying segregation and covariates.
  
  
  CONCLUSIONS
  The association of residential segregation with cardiovascular risk varies according to race/ethnicity. Further work is needed to better characterize the individual- and neighborhood-level pathways linking segregation to CVD risk.
authors.affiliation: From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.N.K., P.J.D.C.); Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN (T.L.O.); Departments of Public Health Policy & Administration, and Epidemiology, University of Wisconsin-Milwaukee, Milwaukee, WI (D.P.D.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.R.). k-kershaw@northwestern.edu.
authors.forename: Kiarri N
authors.initials: KN
authors.lastname: Kershaw
authors.affiliation: From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.N.K., P.J.D.C.); Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN (T.L.O.); Departments of Public Health Policy & Administration, and Epidemiology, University of Wisconsin-Milwaukee, Milwaukee, WI (D.P.D.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.R.).
authors.forename: Theresa L
authors.initials: TL
authors.lastname: Osypuk
authors.affiliation: From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.N.K., P.J.D.C.); Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN (T.L.O.); Departments of Public Health Policy & Administration, and Epidemiology, University of Wisconsin-Milwaukee, Milwaukee, WI (D.P.D.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.R.).
authors.forename: D Phuong
authors.initials: DP
authors.lastname: Do
authors.affiliation: From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.N.K., P.J.D.C.); Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN (T.L.O.); Departments of Public Health Policy & Administration, and Epidemiology, University of Wisconsin-Milwaukee, Milwaukee, WI (D.P.D.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.R.).
authors.forename: Peter J
authors.initials: PJ
authors.lastname: De Chavez
authors.affiliation: From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.N.K., P.J.D.C.); Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN (T.L.O.); Departments of Public Health Policy & Administration, and Epidemiology, University of Wisconsin-Milwaukee, Milwaukee, WI (D.P.D.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.R.).
authors.forename: Ana V
authors.initials: AV
authors.lastname: Diez Roux
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000706:statistics & numerical data*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000208:ethnology*; D003920:Diabetes Mellitus / Q000453:epidemiology; D050171:Dyslipidemias / Q000453:epidemiology; D004777:Environment; D005260:Female; D054624:Health Status Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006798:Housing / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D008019:Life Style; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D063505:Racism / Q000706:statistics & numerical data; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American
keywords: cardiovascular diseases; continental population groups; epidemiology; ethnic groups; residence characteristics