Heart Attacks More Likely in ‘Disadvantaged’ Neighborhoods, New England Journal of Medicine Study Finds

Residents of disadvantaged neighborhoods have a higher risk of coronary heart disease than residents of wealthier neighborhoods -- independent of established risk factors, such as occupation, income and education, according to a study in today's New England Journal of Medicine. Columbia University researchers sampled persons ages 45 to 64 in 1,000-person neighborhoods in four areas: Forsyth County, N.C.; Jackson, Miss.; the northwestern suburbs of Minneapolis, Minn.; and Washington County, Md. Each neighborhood was assigned a collective summary score that included information about wealth, income, education and occupation. Independent of all other factors, compared with those living in the wealthiest neighborhoods, white people living in the poorer group of neighborhoods had a 70% to 90% higher risk of coronary disease and blacks living in the most disadvantaged neighborhoods had a 30% to 50% higher risk (Diez Roux et al., NEJM, 7/12).

Explaining the Results
Researchers provided a number of explanations for the disparity, saying that neighborhoods could differ in the amount of tobacco advertising for tobacco -- a substance that increases heart disease risk -- and availability and cost of "healthful foods." Further, wealthier areas might have parks and recreation areas that encourage people to exercise, while poorer areas might be perceived as "dangerous," thus discouraging residents from going outside. Further, noise, violence and poverty in poor neighborhoods could create "chronic stress," which might lead to heart attacks. Dr. Michael Alderman, professor of medicine and epidemiology at New York-based Albert Einstein College of Medicine, said that the study "demonstrates that environment isn't just the personal experience -- your behaviors like cigar smoking and jogging and cholesterol. Your environment can be of a communal nature" (AP/Baltimore Sun, 7/12). Lead author Dr. Ana Diez Roux, a Columbia University professor, added, "When we look at the causes of heart disease, we need to look at not only the characteristics of the individual but also of the environment where they live and work" (Miller, Raleigh News & Observer, 7/12). She added that the study's findings could be an important factor in "establishing public priorities," pointing out that economic segregation of residential areas also "appears likely to increase health disparities." She suggested the results could be "an argument in favor of dispersing affordable housing throughout a variety of neighborhoods, instead of concentrating it in a few" (Marcotty, Minneapolis Star Tribune, 7/12). An abstract of the NEJM study is available online.