The influence of neighbourhood-level socioeconomic deprivation on cardiovascular disease mortality in older age: longitudinal multilevel analyses from a cohort of older British men.
BACKGROUND
Evidence from longitudinal studies on the influence of neighbourhood socioeconomic factors in older age on cardiovascular disease (CVD) mortality is limited. We aimed to investigate the prospective association of neighbourhood-level deprivation in later life with CVD mortality, and assess the underlying role of established cardiovascular risk factors.


METHODS
A socially representative cohort of 3924 men, aged 60-79 years in 1998-2000, from 24 British towns, was followed up until 2012 for CVD mortality. Quintiles of the national Index of Multiple Deprivation (IMD), a composite score of neighbourhood-level factors (including income, employment, education, housing and living environment) were used. Multilevel logistic regression with discrete-time models (stratifying follow-up time into months) were used.


RESULTS
Over 12 years, 1545 deaths occurred, including 580 from CVD. The risk of CVD mortality showed a graded increase from IMD quintile 1 (least deprived) to 5 (most deprived). Compared to quintile 1, the age-adjusted odds of CVD mortality in quintile 5 were 1.71 (95% CI 1.32 to 2.21), and 1.62 (95% CI 1.23 to 2.13) on further adjustment for individual social class, which was attenuated slightly to 1.44 (95% CI 1.09 to 1.89), but remained statistically significant after adjustment for smoking, body mass index, physical activity and use of alcohol. Further adjustment for blood pressure, high-density lipoprotein cholesterol and prevalent diabetes made little difference.


CONCLUSIONS
Neighbourhood-level deprivation was associated with an increased risk of CVD mortality in older people independent of individual-level social class and cardiovascular risk factors. The role of other specific neighbourhood-level factors merits further research.
Department of Primary Care & Population Health, UCL, London, UK.
S E
SE
Ramsay
Department of Primary Care & Population Health, UCL, London, UK.
R W
RW
Morris
Division of Population Health Sciences and Education, St George's University of London, London, UK.
P H
PH
Whincup
Department of Social and Behavioural Science, Harvard University, Boston, Massachusetts, USA.
S V
SV
Subramanian
Department of Primary Care & Population Health, UCL, London, UK.
A O
AO
Papacosta
Department of Primary Care & Population Health, UCL, London, UK.
Lucy T
LT
Lennon
Department of Primary Care & Population Health, UCL, London, UK.
S G
SG
Wannamethee
D000368:Aged; D002318:Cardiovascular Diseases / Q000191:economics / Q000401:mortality*; D002423:Cause of Death; D004651:Employment / Q000145:classification / Q000191:economics; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D055361:Multilevel Analysis; D011204:Poverty Areas; D011446:Prospective Studies; D012111:Residence Characteristics / Q000145:classification*; D012307:Risk Factors; D012923:Social Class; D006113:United Kingdom / Q000453:epidemiology
AGEING; Cardiovascular disease; DEPRIVATION; INEQUALITIES; MULTILEVEL MODELLING