Advertisement

International Journal of Behavioral Medicine

, Volume 23, Issue 1, pp 112–120 | Cite as

Neighbourhood Deprivation, Individual-Level and Familial-Level Socio-demographic Factors and Risk of Congenital Heart Disease: A Nationwide Study from Sweden

  • Xinjun LiEmail author
  • Jan Sundquist
  • Tsuyoshi Hamano
  • Bengt Zöller
  • Kristina Sundquist
Article

Abstract

Objectives

The purpose of the study is to examine whether there is an association between neighbourhood deprivation and incidence of congenital heart disease (CHD), after accounting for family- and individual-level potential confounders.

Methods

All children aged 0 to 11 years and living in Sweden (n = 748,951) were followed between January 1, 2000 and December 31, 2010. Data were analysed by multilevel logistic regression, with family- and individual-level characteristics at the first level and level of neighbourhood deprivation at the second level.

Results

During the study period, among a total of 748,951 children, 1499 (0.2 %) were hospitalised with CHD. Age-adjusted cumulative hospitalisation rates for CHD increased with increasing level of neighbourhood deprivation. In the study population, 1.8 per 1000 and 2.2 per 1000 children in the least and most deprived neighbourhoods, respectively, were hospitalised with CHD. The incidence of hospitalisation for CHD increased with increasing neighbourhood-level deprivation across all family and individual-level socio-demographic categories. The odds ratio (OR) for hospitalisation for CHD for those living in high-deprivation neighbourhoods versus those living in low-deprivation neighbourhoods was 1.23 (95 % confidence interval (CI) = 1.04–1.46). In the full model, which took account for age, paternal and maternal individual-level socio-economic characteristics, comorbidities (e.g. maternal type 2 diabetes, OR = 3.03; maternal hypertension, OR = 2.01), and family history of CHD (OR = 3.27), the odds of CHD were slightly attenuated but did not remain significant in the most deprived neighbourhoods (OR = 1.20, 95 % CI = 0.99–1.45, p = 0.057).

Conclusions

This study is the largest so far on neighbourhood influences on CHD, and the results suggest that deprived neighbourhoods have higher rates of CHD, which represents important clinical knowledge. However, the association does not seem to be independent of individual- and family-level characteristics.

Keywords

Congenital heart disease Neighbourhood-level deprivation Incidence Socio-demographic factors Multilevel modelling 

Notes

Acknowledgments

The authors wish to thank Science Editor Stephen Gilliver for his useful comments on the text. This work was supported by ALF funding from Region Skåne awarded to Jan Sundquist, Bengt Zöller and Kristina Sundquist; the Swedish Research Council (awarded to Kristina Sundquist); grants to Dr Bengt Zöller from the Swedish Heart-Lung Foundation and the Swedish Research Council. Research reported in this publication was also supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number R01HL116381 to Kristina Sundquist. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The registers used in the present study are maintained by Statistics Sweden and the National Board of Health and Welfare.

Conflict of Interest

Xinjun Li, Jan Sundquist, Tsuyoshi Hamano, Bengt Zöller, and Kristina Sundquist declare that they have no conflict of interest.

Supplementary material

12529_2015_9488_MOESM1_ESM.docx (30 kb)
Supplementary Table 1 (DOCX 30 kb)
12529_2015_9488_MOESM2_ESM.docx (29 kb)
Supplementary Table 2 (DOCX 28 kb)

References

  1. 1.
    Blue GM, Kirk EP, Sholler GF, Harvey RP, Winlaw DS. Congenital heart disease: current knowledge about causes and inheritance. Med J Aust. 2012;197:155–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Hoffman JI. Congenital heart disease: incidence and inheritance. Pediatr Clin N Am. 1990;37:25–43.Google Scholar
  3. 3.
    Marino BS, Lipkin PH, Newburger JW, et al. Neurodevelopmental outcomes in children with congenital heart disease: evaluation and management: a scientific statement from the American Heart Association. Circulation. 2012;126:1143–72.CrossRefPubMedGoogle Scholar
  4. 4.
    Rodan L, McCrindle BW, Manlhiot C, et al. Stroke recurrence in children with congenital heart disease. Ann Neurol. 2012;72:103–11.CrossRefPubMedGoogle Scholar
  5. 5.
    Oyen N, Poulsen G, Wohlfahrt J, et al. Recurrence of discordant congenital heart defects in families. Circ Cardiovasc Genet. 2010;3:122–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Romano-Zelekha O, Hirsh R, Blieden L, Green M, Shohat T. The risk for congenital heart defects in offspring of individuals with congenital heart defects. Clin Genet. 2001;59:325–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Mangones T, Manhas A, Visintainer P, Hunter-Grant C, Brumberg HL. Prevalence of congenital cardiovascular malformations varies by race and ethnicity. Int J Cardiol. 2010;143:317–22.CrossRefPubMedGoogle Scholar
  8. 8.
    Mills JL, Troendle J, Conley MR, Carter T, Druschel CM. Maternal obesity and congenital heart defects: a population-based study. Am J Clin Nutr. 2010;91:1543–9.PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Alverson CJ, Strickland MJ, Gilboa SM, Correa A. Maternal smoking and congenital heart defects in the Baltimore-Washington Infant Study. Pediatrics. 2011;127:e647–53.CrossRefPubMedGoogle Scholar
  10. 10.
    Hackshaw A, Rodeck C, Boniface S. Maternal smoking in pregnancy and birth defects: a systematic review based on 173 687 malformed cases and 11.7 million controls. Hum Reprod Update. 2011;17:589–604.PubMedCentralCrossRefPubMedGoogle Scholar
  11. 11.
    Macintosh MC, Fleming KM, Bailey JA, et al. Perinatal mortality and congenital anomalies in babies of women with type 1 or type 2 diabetes in England, Wales, and Northern Ireland: population based study. BMJ. 2006;333:177.PubMedCentralCrossRefPubMedGoogle Scholar
  12. 12.
    Ul Haq F, Jalil F, Hashmi S, et al. Risk factors predisposing to congenital heart defects. Ann Pediatr Cardiol. 2011;4:117–21.PubMedCentralCrossRefPubMedGoogle Scholar
  13. 13.
    Levy HL, Guldberg P, Guttler F, et al. Congenital heart disease in maternal phenylketonuria: report from the Maternal PKU Collaborative Study. Pediatr Res. 2001;49:636–42.CrossRefPubMedGoogle Scholar
  14. 14.
    Luteijn JM, Brown MJ, Dolk H. Influenza and congenital anomalies: a systematic review and meta-analysis. Hum Reprod. 2014;29:809–23.CrossRefPubMedGoogle Scholar
  15. 15.
    Thulstrup AM, Bonde JP. Maternal occupational exposure and risk of specific birth defects. Occup Med. 2006;56:532–43.CrossRefGoogle Scholar
  16. 16.
    Gilboa SM, Desrosiers TA, Lawson C, et al. Association between maternal occupational exposure to organic solvents and congenital heart defects, National Birth Defects Prevention Study, 1997–2002. Occup Environ Med. 2012;69:628–35.PubMedCentralCrossRefPubMedGoogle Scholar
  17. 17.
    Langlois PH, Brender JD, Suarez L, et al. Maternal residential proximity to waste sites and industrial facilities and conotruncal heart defects in offspring. Paediatr Perinat Epidemiol. 2009;23:321–31.CrossRefPubMedGoogle Scholar
  18. 18.
    Limbers CA, Emery K, Uzark K. Factors associated with perceived cognitive problems in children and adolescents with congenital heart disease. J Clin Psychol Med Settings. 2012.doi: 10.1007/s10880-012-9326-z.Google Scholar
  19. 19.
    Agha MM, Glazier RH, Moineddin R, Moore AM, Guttmann A. Socioeconomic status and prevalence of congenital heart defects: does universal access to health care system eliminate the gap? Birth Defects Res A Clin Mol Teratol. 2011;91:1011–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Gorini F, Chiappa E, Gargani L, Picano E. Potential effects of environmental chemical contamination in congenital heart disease. Pediatr Cardiol. 2014;35:559–568.Google Scholar
  21. 21.
    Hart D, Atkins R, Matsuba MK. The association of neighborhood poverty with personality change in childhood. J Pers Soc Psychol. 2008;94:1048–61.CrossRefPubMedGoogle Scholar
  22. 22.
    Singh GK, Kogan MD, van Dyck PC. A multilevel analysis of state and regional disparities in childhood and adolescent obesity in the United States. J Community Health. 2008;33:90–102.CrossRefPubMedGoogle Scholar
  23. 23.
    Navalpotro L, Regidor E, Ortega P, et al. Area-based socioeconomic environment, obesity risk behaviours, area facilities and childhood overweight and obesity: socioeconomic environment and childhood overweight. Prev Med. 2012;55:102–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Kroll ME, Stiller CA, Murphy MF, Carpenter LM. Childhood leukaemia and socioeconomic status in England and Wales 1976–2005: evidence of higher incidence in relatively affluent communities persists over time. Br J Cancer. 2011;105:1783–7.PubMedCentralCrossRefPubMedGoogle Scholar
  25. 25.
    Shih M, Dumke K, Goran MI, Simon P. The association between community-level economic hardship and childhood obesity prevalence in Los Angeles. Pediatr Obes. 2012;8:411–7.Google Scholar
  26. 26.
    Bammann K, Gwozdz W, Lanfer A, et al. Socioeconomic factors and childhood overweight in Europe: results from the multi-centre IDEFICS study. Pediatr Obes. 2013;8:1–12.CrossRefPubMedGoogle Scholar
  27. 27.
    El-Sayed AM, Scarborough P, Galea S. Socioeconomic inequalities in childhood obesity in the United Kingdom: a systematic review of the literature. Obes Facts. 2012;5:671–92.CrossRefPubMedGoogle Scholar
  28. 28.
    Grigsby-Toussaint DS, Lipton R, Chavez N, et al. Neighborhood socioeconomic change and diabetes risk: findings from the Chicago childhood diabetes registry. Diabetes Care. 2010;33:1065–8.PubMedCentralCrossRefPubMedGoogle Scholar
  29. 29.
    Rosen M, Hakulinen T. Use of disease registers. In: Ahrens W, Pigeot I, editors. Handbook of epidemiology. Berlin: Springer-Verlag; 2005. p. 232–51.Google Scholar
  30. 30.
    Cubbin C, Sundquist K, Ahlen H, et al. Neighborhood deprivation and cardiovascular disease risk factors: protective and harmful effects. Scand J Public Health. 2006;34:228–37.CrossRefPubMedGoogle Scholar
  31. 31.
    Sundquist J, Johansson SE, Yang M, Sundquist K. Low linking social capital as a predictor of coronary heart disease in Sweden: a cohort study of 2.8 million people. Soc Sci Med. 2006;62:954–63.CrossRefPubMedGoogle Scholar
  32. 32.
    Winkleby M, Sundquist K, Cubbin C. Inequities in CHD incidence and case fatality by neighborhood deprivation. Am J Prev Med. 2007;32:97–106.PubMedCentralCrossRefPubMedGoogle Scholar
  33. 33.
    Sundquist K, Theobald H, Yang M, et al. Neighborhood violent crime and unemployment increase the risk of coronary heart disease: a multilevel study in an urban setting. Soc Sci Med. 2006;62:2061–71.CrossRefPubMedGoogle Scholar
  34. 34.
    Johnell K, Lindstrom M, Melander A, et al. Anxiolytic-hypnotic drug use associated with trust, social participation, and the miniaturization of community: a multilevel analysis. Soc Sci Med. 2006;62:1205–14.CrossRefPubMedGoogle Scholar
  35. 35.
    Johnell K, Lindstrom M, Sundquist J, Eriksson C, Merlo J. Individual characteristics, area social participation, and primary non-concordance with medication: a multilevel analysis. BMC Public Health. 2006;6:52.PubMedCentralCrossRefPubMedGoogle Scholar
  36. 36.
    Lee LJ, Lupo PJ. Maternal smoking during pregnancy and the risk of congenital heart defects in offspring: a systematic review and metaanalysis. Pediatr Cardiol. 2012;34:398–407.Google Scholar
  37. 37.
    Lupo PJ, Symanski E, Langlois PH, et al. Maternal occupational exposure to polycyclic aromatic hydrocarbons and congenital heart defects among offspring in the national birth defects prevention study. Birth Defects Res A Clin Mol Teratol. 2012;94:875–81.PubMedCentralCrossRefPubMedGoogle Scholar
  38. 38.
    Franklin WJ, Gandhi M. Congenital heart disease in pregnancy. Cardiol Clin. 2012;30:383–94.CrossRefPubMedGoogle Scholar
  39. 39.
    Lofors J, Sundquist K. Low-linking social capital as a predictor of mental disorders: a cohort study of 4.5 million Swedes. Soc Sci Med. 2007;64:21–34.CrossRefPubMedGoogle Scholar
  40. 40.
    Sundquist K, Yang M. Linking social capital and self-rated health: a multilevel analysis of 11,175 men and women in Sweden. Health Place. 2007;13:324–34.CrossRefPubMedGoogle Scholar
  41. 41.
    Daniel M, Moore S, Kestens Y. Framing the biosocial pathways underlying associations between place and cardiometabolic disease. Health Place. 2008;14:117–32.CrossRefPubMedGoogle Scholar
  42. 42.
    Brosschot JF, Benschop RJ, Godaert GL, et al. Influence of life stress on immunological reactivity to mild psychological stress. Psychosom Med. 1994;56:216–24.CrossRefPubMedGoogle Scholar
  43. 43.
    McEwen BS, Biron CA, Brunson KW, et al. The role of adrenocorticoids as modulators of immune function in health and disease: neural, endocrine and immune interactions. Brain Res Brain Res Rev. 1997;23:79–133.CrossRefPubMedGoogle Scholar
  44. 44.
    Diller GP, Inuzuka R, Kempny A, et al. Detrimental impact of socioeconomic status on exercise capacity in adults with congenital heart disease. Int J Cardiol. 2011;165:80–6.Google Scholar
  45. 45.
    Lynch J, Smith GD, Hillemeier M, et al. Income inequality, the psychosocial environment, and health: comparisons of wealthy nations. Lancet. 2001;358:194–200.CrossRefPubMedGoogle Scholar
  46. 46.
    Lochner K, Pamuk E, Makuc D, Kennedy BP, Kawachi I. State-level income inequality and individual mortality risk: a prospective, multilevel study. Am J Public Health. 2001;91:385–91.PubMedCentralCrossRefPubMedGoogle Scholar
  47. 47.
    van Doorslaer E, Wagstaff A, Bleichrodt H, et al. Income-related inequalities in health: some international comparisons. J Health Econ. 1997;16:93–112.CrossRefPubMedGoogle Scholar
  48. 48.
    Bottiger M, Forsgren M. Twenty years’ experience of rubella vaccination in Sweden: 10 years of selective vaccination (of 12-year-old girls and of women postpartum) and 13 years of a general two-dose vaccination. Vaccine. 1997;15:1538–44.CrossRefPubMedGoogle Scholar
  49. 49.
    Ludvigsson JF, Andersson E, Ekbom A, et al. External review and validation of the Swedish national inpatient register. BMC Public Health. 2011;11:450.PubMedCentralCrossRefPubMedGoogle Scholar
  50. 50.
    Centre for Epidemiology. Validity of the diagnoses from the Swedish In-Care Register 1987 and 1995 Swedish. Stockholm: the National Board of Health and Welfare 2000.Google Scholar

Copyright information

© International Society of Behavioral Medicine 2015

Authors and Affiliations

  • Xinjun Li
    • 1
    Email author
  • Jan Sundquist
    • 1
    • 2
  • Tsuyoshi Hamano
    • 3
  • Bengt Zöller
    • 1
  • Kristina Sundquist
    • 1
    • 2
  1. 1.Center for Primary Health Care ResearchLund University/Region Skåne CRCMalmöSweden
  2. 2.Stanford Prevention Research CenterStanford University School of MedicineStanfordUSA
  3. 3.Centre for Community-based Health Research and Education (COHRE), Organization for the Promotion of Project ResearchShimane UniversityIzumoJapan

Personalised recommendations