TY - JOUR
T1 - Variation in Rates of Fatal Coronary Heart Disease by Neighborhood Socioeconomic Status
T2 - The Atherosclerosis Risk in Communities Surveillance (1992-2002)
AU - Foraker, Randi E.
AU - Rose, Kathryn M.
AU - Kucharska-Newton, Anna M.
AU - Ni, Hanyu
AU - Suchindran, Chirayath M.
AU - Whitsel, Eric A.
N1 - Funding Information:
The Atherosclerosis Risk in Communities Study is carried out as a collaborative study supported by the National Heart, Lung, and Blood Institute (N01-HC-55015, N01-HC-55016, N01-HC-55018, N01-HC-55019, N01-HC-55020, N01-HC-55021, N01-HC-55022) . The authors thank the staff of the ARIC study for their important contributions.
PY - 2011/8
Y1 - 2011/8
N2 - Purpose: Racial and gender disparities in out-of-hospital deaths from coronary heart disease (CHD) have been well-documented, yet disparities by neighborhood socioeconomic status (nSES) have been less systematically studied in US population-based surveillance efforts. Methods: We examined the association of nSES, classified into tertiles, with 3,743 out-of-hospital fatal CHD events, and a subset of 2,191 events classified as sudden, among persons aged 35 to 74 years in four US communities under surveillance by the Atherosclerosis Risk in Communities (ARIC). Poisson generalized linear mixed models generated age-, race- (white, black) and gender-specific standardized mortality rate ratios and 95% confidence intervals (RR, 95% CI). Results: Regardless of nSES measure used, inverse associations of nSES with all out-of-hospital fatal CHD and sudden fatal CHD were seen in all race-gender groups. The magnitude of these associations was larger among women than men. Further, among blacks, associations of low nSES (vs. high nSES) were stronger for sudden cardiac deaths (SCD) than for all out-of-hospital fatal CHD. Conclusions: Low nSES was associated with an increased risk of out-of-hospital CHD death and SCD. Measures of the neighborhood context are useful tools in population-based surveillance efforts for documenting and monitoring socioeconomic disparities in mortality over time.
AB - Purpose: Racial and gender disparities in out-of-hospital deaths from coronary heart disease (CHD) have been well-documented, yet disparities by neighborhood socioeconomic status (nSES) have been less systematically studied in US population-based surveillance efforts. Methods: We examined the association of nSES, classified into tertiles, with 3,743 out-of-hospital fatal CHD events, and a subset of 2,191 events classified as sudden, among persons aged 35 to 74 years in four US communities under surveillance by the Atherosclerosis Risk in Communities (ARIC). Poisson generalized linear mixed models generated age-, race- (white, black) and gender-specific standardized mortality rate ratios and 95% confidence intervals (RR, 95% CI). Results: Regardless of nSES measure used, inverse associations of nSES with all out-of-hospital fatal CHD and sudden fatal CHD were seen in all race-gender groups. The magnitude of these associations was larger among women than men. Further, among blacks, associations of low nSES (vs. high nSES) were stronger for sudden cardiac deaths (SCD) than for all out-of-hospital fatal CHD. Conclusions: Low nSES was associated with an increased risk of out-of-hospital CHD death and SCD. Measures of the neighborhood context are useful tools in population-based surveillance efforts for documenting and monitoring socioeconomic disparities in mortality over time.
KW - Out-of-Hospital Death
KW - Socioeconomic Status
KW - Surveillance
UR - http://www.scopus.com/inward/record.url?scp=79959944000&partnerID=8YFLogxK
U2 - 10.1016/j.annepidem.2011.03.004
DO - 10.1016/j.annepidem.2011.03.004
M3 - Article
C2 - 21524592
AN - SCOPUS:79959944000
SN - 1047-2797
VL - 21
SP - 580
EP - 588
JO - Annals of Epidemiology
JF - Annals of Epidemiology
IS - 8
ER -