title: Impact of neighborhood resources on cardiovascular disease: a nationwide six-year follow-up.
abstract: Living in a socially deprived neighborhood is associated with lifestyle risk factors, e.g., smoking, physical inactivity and unhealthy diet, as well as an increased risk of cardiovascular disease, i.e., coronary heart disease and stroke. The aim was to study whether the odds of cardiovascular disease vary with the neighbourhood availability of potentially health-damaging and health-promoting resources.
  
  
  
  A nationwide sample of 2 040 826 men and 2 153 426 women aged 35-80 years were followed for six years for first hospitalization of coronary heart disease or stroke. Neighborhood availability of health-damaging resources (i.e., fast-food restaurants and bars/pubs) and health-promoting resources (i.e., health care facilities and physical activity facilities) were determined by use of geographic information systems (GIS).
  
  
  
  We found small or modestly increased odds ratios (ORs) for both coronary heart disease and stroke, related to the availability of both health-damaging and health-promoting resources. For example, in women, the unadjusted OR (95 % confidence interval) for stroke in relation to availability of fast-food restaurants was 1.18 (1.15-1.21). Similar patterns were observed in men, with an OR = 1.08 (1.05-1.10). However, the associations became weaker or disappeared after adjustment for neighborhood-level deprivation and individual-level age and income.
  
  
  
  This six year follow-up study shows that neighborhood availability of potentially health-damaging as well as health-promoting resources may make a small contribution to the risk of coronary heart disease and stroke. However, most of these associations were attenuated or disappeared after adjustment for neighborhood-level deprivation and individual-level age and income. Future studies are needed to further examine factors in the causal pathway between neighborhood deprivation and cardiovascular disease.
authors.affiliation: Department of Clinical Sciences, Center for Primary Health Care Research, Skåne University Hospital, Lund University, Clinical Research Centre (CRC), Building 28, floor 11, Jan Waldenströms gata 35, 205 02, Malmö, Sweden. susanna.calling@med.lu.se.
authors.forename: Susanna
authors.initials: S
authors.lastname: Calling
authors.affiliation: Department of Clinical Sciences, Center for Primary Health Care Research, Skåne University Hospital, Lund University, Clinical Research Centre (CRC), Building 28, floor 11, Jan Waldenströms gata 35, 205 02, Malmö, Sweden.
authors.forename: Xinjun
authors.initials: X
authors.lastname: Li
authors.affiliation: Waseda Institute of Sport Sciences, Waseda University, Tokorozawa Saitama, Japan.
authors.forename: Naomi
authors.initials: N
authors.lastname: Kawakami
authors.affiliation: Center for Community-based Health Research and Education (COHRE), Organization for the Promotion of Project Research, Shimane University, Izumo, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Hamano
authors.affiliation: Department of Clinical Sciences, Center for Primary Health Care Research, Skåne University Hospital, Lund University, Clinical Research Centre (CRC), Building 28, floor 11, Jan Waldenströms gata 35, 205 02, Malmö, Sweden.|Stanford Prevention Research Center, Stanford University, Stanford, CA, USA.
authors.forename: Kristina
authors.initials: K
authors.lastname: Sundquist
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology*; D003324:Coronary Artery Disease / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D040362:Geographic Information Systems; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008019:Life Style; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012111:Residence Characteristics; D012147:Restaurants / Q000706:statistics & numerical data; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000209:etiology
keywords: Cardiovascular disease; Follow-up study; Multilevel analysis; Neighborhood