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APHA Scientific Session and Event Listing

Recorded presentation

Basile Chaix, Dr¹, Pierre Chauvin, MD PhD², and Juan Merlo, Pr¹. (1) Department of Clinical Sciences, Malmö University Hospital, Lund University, S–205 02, Malmö, Sweden, 00 33 1 44 73 86 64, basile.chaix@med.lu.se, (2) Research team on the social determinants of health and healthcare (UMR-S 707), Inserm, 27 rue Chaligny, Paris, F-75012, France

Previous literature has shown that the socioeconomic level of the residential neighborhood may have an effect on ischemic heart disease (IHD) risk. To expand on this, we used a 34-year longitudinal database to assess whether neighborhood socioeconomic effects on IHD had increased/diminished over the recent period. Moreover, to gain insight into the underlying mechanisms, we examined whether neighborhood residential stability (as a determinant of social interaction patterns) had an influence on IHD risk. Finally, we compared contextual effects operating on incidence, 1-day case-fatality, and survival after acute myocardial infarction (AMI). We used two large Swedish cohorts, defined in 1986 and 1996, including income over the past 20 years and follow-up of hospital diagnoses and causes of mortality over the period. Using multilevel and spatial models to describe patterns of geographic variation, we found that IHD risk regularly increased with neighborhood socioeconomic deprivation, after adjustment for individual sociodemographic factors. We observed that neighborhood socioeconomic effects had markedly increased between the 1986 and 1996 cohorts, which was partly due to the increase of social segregation (or spatial concentration of poverty) over the period. Beyond individual and neighborhood socioeconomic effects, we found no influence of residential stability on IHD incidence, but observed a markedly higher case-fatality and shorter post-AMI long-term survival in residentially unstable neighborhoods. Such residential instability effects may be mediated by the lower availability of social support in residentially unstable neighborhoods. Investigating the mediating pathways of neighborhood effects is critical in a period characterized by an increase of neighborhood socioeconomic influences.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

• Identify different structural characteristics of the residential context (socioeconomic environment, residential stability, population density) that are associated with the risk of ischemic heart disease.
• Recognize that contextual studies need to investigate comparatively neighborhood effects at the different stages of the disease process (i.e., on incidence, case-fatality, and long-term survival after acute myocardial infarction).
• Understand that it is necessary to investigate the exact mediating mechanisms through which neighborhood characteristics influence coronary health, in order to draw more definite conclusions on the existence or not of truly contextual effects.

Keywords: Environment, Social Class

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation