Key result
Living in the most socioeconomically deprived neighbourhoods was associated with an increased risk of cardiovascular mortality compared to the least deprived (OR 1.44; 95% CI 1.09-1.89).
Why the study?
Does neighbourhood-level socioeconomic deprivation increase cardiovascular disease mortality in older British men?
Cohort (n=3,924)
Yes
Does neighbourhood-level socioeconomic deprivation increase cardiovascular disease mortality in older British men?
Neighbourhood-level socioeconomic deprivation is independently associated with an increased risk of cardiovascular disease mortality in older men, highlighting the importance of area-level factors beyond individual risk profiles.
Supports considering neighbourhood deprivation in older men's CVD risk assessment; leaves open causal mechanisms and intervention effects.
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.
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Ramsay et al. (2015) conducted a cohort in Cardiovascular disease mortality (n=3,924). Neighbourhood-level socioeconomic deprivation (IMD quintile 5) vs. Least deprived neighbourhood (IMD quintile 1) was evaluated on CVD mortality (OR 1.44, 95% CI 1.09 to 1.89). Living in the most socioeconomically deprived neighbourhoods was associated with an increased risk of cardiovascular mortality compared to the least deprived (OR 1.44; 95% CI 1.09-1.89).
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