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Subclinical coronary atherosclerosis and neighbourhood deprivation in an urban region

  • Cardiovascular Disease
  • Published:
European Journal of Epidemiology Aims and scope Submit manuscript

Abstract

Inhabitants of deprived neighbourhoods are at higher risk of coronary heart disease. In this study we investigate the hypothesis that social inequalities at neighbourhood level become already manifest in subclinical coronary atherosclerosis, as defined by electron-beam computed tomography derived measures. Coronary artery calcification was assessed as a marker of atherosclerosis in a population based sample of 4301 men and women (45–75 years) without a history of coronary heart disease. Participants lived in three adjacent cities in Germany and were examined between 2000 and 2003 as part of the Heinz Nixdorf Recall Study. Individual level data was combined with neighbourhood level information about unemployment, welfare and living space per inhabitant. This dataset was analysed with descriptive and multilevel regression methods. An association between neighbourhood deprivation and subclinical coronary calcification was observed. After adjustment for age and individual socioeconomic status male inhabitants of high unemployment neighbourhoods had an odds ratio of 1.45 (1.11, 1.96) of exhibiting a high calcification score (>75th percentile) compared to men living in low unemployment areas. The respective odds for women was 1.29 (0.97, 1.70). Additional explorative analyses suggest that clustering of unhealthy lifestyles in deprived neighbourhoods contributes to the observed association. In conclusion, findings suggest that certain neighbourhood characteristics promote the emergence of coronary atherosclerosis. This might point to a pathway from neighbourhood deprivation to manifest coronary heart disease.

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Abbreviations

BMI:

Body mass index

CAC:

Coronary artery calcification

CHD:

Coronary heart disease

EBCT:

Electron-beam computed tomography

HNR:

Heinz Nixdorf Recall Study

SES:

Socioeconomic status

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Acknowledgments and funding

We thank the Heinz Nixdorf Foundation (Chairman: Dr. jur. G. Schmidt) for generous support of the Heinz Nixdorf Study. The study is also supported by the German Ministry of Education and Science. An additional research grant was received from Imatron Inc., South San Francisco, CA, which produced the EBCT scanners, and GE-Imatron, South San Francisco, CA, after the acquisition of Imatron Inc. Assessment of psychosocial factors and neighbourhood level information is funded by the German Research Council (DFG; Project SI 236/8-1 and SI 236/9-1). We are indebted to the investigative group and the study personnel, in particular E. M. Beck, Dr. M. Bröker-Preuß, U. Roggenbuck. We gratefully acknowledge the collaboration with: Prof. Dr. Grönemeyer and Prof. Dr. R. Seibel. Also we are grateful to H. Feldmann (City Council Bochum), F. Beyer (City Council Essen) and H. J. Libera (City Council Mülheim an der Ruhr).

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Authors and Affiliations

  1. Department of Medical Sociology, Heinrich-Heine-University, PO 10 10 07, Duesseldorf, 40001, Germany

    Nico Dragano, Pablo E. Verde, Simone Weyers & Johannes Siegrist

  2. Institute for Medical Informatics, Biometry and Epidemiology, University Duisburg-Essen, Essen, Germany

    Barbara Hoffmann, Susanne Moebus & Karl-Heinz Jöckel

  3. Institute of Medical Epidemiology, Biometry and Informatics, University Hospital of Halle, Halle, Germany

    Andreas Stang

  4. Clinic of Cardiology, West-German Heart Center Essen, University Duisburg-Essen, Essen, Germany

    Stefan Möhlenkamp, Axel Schmermund & Raimund Erbel

  5. Department of Endocrinology and Division of Laboratory Research, University Clinic Essen, Essen, Germany

    Klaus Mann

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  1. Nico Dragano
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  2. Barbara Hoffmann
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  3. Andreas Stang
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Heinz Nixdorf Recall Study Investigative Group

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Correspondence to Nico Dragano.

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Dragano, N., Hoffmann, B., Stang, A. et al. Subclinical coronary atherosclerosis and neighbourhood deprivation in an urban region. Eur J Epidemiol 24, 25–35 (2009). https://doi.org/10.1007/s10654-008-9292-9

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