Abstract
BackgroundPrevious studies have shown that deprived neighbourhoods have higher cardiovascular mortality and morbidity rates. Inequalities in the distribution of behaviour related risk factors are one possible explanation for this trend. In our study, we examined the association between cardiovascular risk factors and neighbourhood characteristics. To assess the consistency of associations the design is cross-national with data from nine industrial towns from the Czech Republic and Germany.MethodsWe combined datasets from two population based studies, one in Germany ('Heinz Nixdorf Recall (HNR) Study'), and one in the Czech Republic ('Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE) Study'). Participation rates were 56% in the HNR and 55% in the HAPIEE study. The subsample for this particular analysis consists of 11,554 men and women from nine German and Czech towns. Census based information on social characteristics of 326 neighbourhoods were collected from local administrative authorities. We used unemployment rate and overcrowding as area-level markers of socioeconomic status (SES). The cardiovascular risk factors obesity, hypertension, smoking and physical inactivity were used as response variables. Regression models were complemented by individual-level social status (education) and relevant covariates.ResultsSmoking, obesity and low physical activity were more common in deprived neighbourhoods in Germany, even when personal characteristics including individual education were controlled for. For hypertension associations were weak. In the Czech Republic associations were observed for smoking and physical inactivity, but not for obesity and hypertension when individual-level covariates were adjusted for. The strongest association was found for smoking in both countries: in the fully adjusted model the odds ratio for 'high unemployment rate' was 1.30 [95% CI 1.02–1.66] in the Czech Republic and 1.60 [95% CI 1.29–1.98] in Germany.ConclusionIn this comparative study, the effects of neighbourhood deprivation varied by country and risk factor; the strongest and most consistent effects were found for smoking. Results indicate that area level SES is associated with health related lifestyles, which might be a possible pathway linking social status and cardiovascular disease. Individual-level education had a considerable influence on the association between neighbourhood characteristics and risk factors.
Highlights
Previous studies have shown that deprived neighbourhoods have higher cardiovascular mortality and morbidity rates
Due to different educational systems vocational degrees are more common in Germany compared to the Czech Republic with more secondary educational degrees
In Germany the unemployment rate is higher than in the Czech Republic, but social isolation was more common among Czechs
Summary
Previous studies have shown that deprived neighbourhoods have higher cardiovascular mortality and morbidity rates. Even at the aggregate level socioeconomic status (SES) seems to be associated with health, as a growing number of studies on relations between neighbourhood-level SES, mortality and morbidity demonstrate [2]. Several studies found a higher all-cause mortality in deprived urban neighbourhoods compared to areas with higher social status [3,4,5,6,7]. This relationship is especially distinct for mortality due to cardiovascular causes [8,9,10,11]. Indicators of morbidity are unequally distributed by neighbourhood SES, for example non fatal coronary heart disease [12,13,14,15] or a self rated poor health [16,17]
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