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Assessment of the magnitude of geographical variations and socioeconomic contextual effects on ischaemic heart disease mortality: a multilevel survival analysis of a large Swedish cohort

Journal of epidemiology and community health (1979), 2007-04, Vol.61 (4), p.349-355 [Peer Reviewed Journal]

Copyright 2007 Journal of Epidemiology and Community Health ;2007 BMJ Publishing Group ;2007 INIST-CNRS ;Copyright: 2007 Copyright 2007 Journal of Epidemiology and Community Health ;Copyright ©2007 BMJ Publishing Group Ltd. ;ISSN: 0143-005X ;ISSN: 1470-2738 ;EISSN: 1470-2738 ;DOI: 10.1136/jech.2006.047597 ;PMID: 17372297 ;CODEN: JECHDR

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Title:
Assessment of the magnitude of geographical variations and socioeconomic contextual effects on ischaemic heart disease mortality: a multilevel survival analysis of a large Swedish cohort
Author: Chaix, Basile ; Rosvall, Maria ; Merlo, Juan
Subjects: Age ; Age Distribution ; Aged ; Biological and medical sciences ; Cardiology. Vascular system ; Cardiovascular disease ; Census of Population ; Community health ; Coronary heart disease ; Epidemiology ; Female ; Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi ; General aspects ; Geographical variation ; Health Sciences ; Health Surveys ; Heart ; Humans ; Hälsovetenskap ; ICD ; IDR ; IHD ; IHR ; Income ; interdecile range ; International Classification of Diseases ; interquartile hazard ratio ; interquartile range ; Investigations ; IQR ; ischaemic heart disease ; Ischemia ; Longitudinal Studies ; Male ; Marital status ; median hazard ratio ; Medical and Health Sciences ; Medical sciences ; Medicin och hälsovetenskap ; MHR ; Middle Aged ; Miscellaneous ; Models, Statistical ; Mortality ; Multilevel models ; Myocardial ischemia ; Myocardial Ischemia - mortality ; Neighborhoods ; Older adults ; Population Density ; Public Health, Global Health, Social Medicine and Epidemiology ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Research Report ; RESEARCH REPORTS ; Risk Factors ; Sex Distribution ; Socioeconomic Factors ; Socioeconomics ; Survival Analysis ; Sweden - epidemiology ; Urban Health ; Variables
Is Part Of: Journal of epidemiology and community health (1979), 2007-04, Vol.61 (4), p.349-355
Description: Background: In a public health perspective, it is of interest to assess the magnitude of geographical variations in ischaemic heart disease (IHD) mortality and quantify the strength of contextual effects on IHD. Objective: To investigate whether area effects vary according to the individual and contextual characteristics of the population, socioeconomic contextual influences were assessed in different age groups and within territories of differing population densities. Design: Multilevel survival analysis of a 28-year longitudinal database. Participants: 341 048 residents of the Scania region in Sweden, reaching age 50–79 years in 1996, followed up over 7 years. Results: After adjustment for several individual socioeconomic indicators over the adult age, Cox multilevel models indicated geographical variations in IHD mortality and socioeconomic contextual effects on the mortality risk. However, the magnitude of geographical variations and strength of contextual effects were modified by the age of individuals and the population density of their residential area: socioeconomic contextual effects were much stronger among non-elderly than among elderly adults, and much larger within urban territories than within rural ones. As a consequence, among non-elderly residents of urban territories, the socioeconomic contextual effect was almost as large as the effect of individual 20-year cumulated income. Conclusions: Non-elderly residents of deprived urban neighbourhoods constitute a major target for both contextual epidemiology of coronary disease and public health interventions aimed at reducing the detrimental effects of the social environment on IHD.
Publisher: London: BMJ Publishing Group Ltd
Language: English
Identifier: ISSN: 0143-005X
ISSN: 1470-2738
EISSN: 1470-2738
DOI: 10.1136/jech.2006.047597
PMID: 17372297
CODEN: JECHDR
Source: ProQuest One Psychology
Geneva Foundation Free Medical Journals at publisher websites
MEDLINE
PubMed Central
Alma/SFX Local Collection
ProQuest Central

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Assessment of the magnitude of geographical variations and socioeconomic contextual effects on ischaemic heart disease mortality: a multilevel survival analysis of a large Swedish cohort

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