Associations of chronic individual-level and neighbourhood-level stressors with incident coronary heart disease

The Multi-Ethnic Study of Atherosclerosis

Kiarri N. Kershaw, Ana V. Diez Roux, Alain Bertoni, Mercedes R. Carnethon, Susan Everson-Rose, Kiang Liu

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12 Citations (Scopus)

Abstract

Background: Several individual-level stressors have been linked to incident coronary heart disease (CHD), but less attention has focused on the influence of neighbourhood-level sources of stress. In this study we examined prospective associations of individual-level and neighbourhood-level stressors with incident CHD. Methods: Multi-Ethnic Study of Atherosclerosis participants aged 45-84 years at baseline (2000-2002) with complete data were included in the analyses (n=6678 for individual-level and n=6105 for neighbourhood-level stressors). CHD was defined as non-fatal myocardial infarction, resuscitated cardiac arrest or CHD death. Median follow-up was 10.2 years. Multivariable Cox proportional hazards models were fitted to estimate associations of individual-level and neighbourhood-level stressors (categorised into approximate tertiles) with incident CHD. Results: Higher reported individual-level stressors were associated with higher incident CHD. Participants in the high individual-level stressor category had 65% higher risk of incident CHD (95% CI 1.23 to 2.22) than those in the low category after adjusting for sociodemographics (P for trend=0.002). This association weakened but remained significant with further adjustment for behavioural and biological risk factors. There was a non-linear relationship between neighbourhood-level stressors and incident CHD (P for quadratic term=0.01). Participants in the medium category had 49% higher CHD risk (95% CI 1.06 to 2.10) compared with those in the low category; those in the high category had only 27% higher CHD risk (95% CI 0.83 to 1.95). These associations persisted with adjustment for risk factors and individual-level stressors. Conclusions: Individual-level and neighbourhood-level stressors were independently associated with incident CHD, though the nature of the relationships differed.

Original languageEnglish (US)
Pages (from-to)136-141
Number of pages6
JournalJournal of Epidemiology and Community Health
Volume69
Issue number2
DOIs
StatePublished - Jan 1 2015

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Coronary Disease
Atherosclerosis
Biological Factors
Heart Arrest
Proportional Hazards Models
Myocardial Infarction
Prospective Studies

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Associations of chronic individual-level and neighbourhood-level stressors with incident coronary heart disease : The Multi-Ethnic Study of Atherosclerosis. / Kershaw, Kiarri N.; Diez Roux, Ana V.; Bertoni, Alain; Carnethon, Mercedes R.; Everson-Rose, Susan; Liu, Kiang.

In: Journal of Epidemiology and Community Health, Vol. 69, No. 2, 01.01.2015, p. 136-141.

Research output: Contribution to journalArticle

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title = "Associations of chronic individual-level and neighbourhood-level stressors with incident coronary heart disease: The Multi-Ethnic Study of Atherosclerosis",
abstract = "Background: Several individual-level stressors have been linked to incident coronary heart disease (CHD), but less attention has focused on the influence of neighbourhood-level sources of stress. In this study we examined prospective associations of individual-level and neighbourhood-level stressors with incident CHD. Methods: Multi-Ethnic Study of Atherosclerosis participants aged 45-84 years at baseline (2000-2002) with complete data were included in the analyses (n=6678 for individual-level and n=6105 for neighbourhood-level stressors). CHD was defined as non-fatal myocardial infarction, resuscitated cardiac arrest or CHD death. Median follow-up was 10.2 years. Multivariable Cox proportional hazards models were fitted to estimate associations of individual-level and neighbourhood-level stressors (categorised into approximate tertiles) with incident CHD. Results: Higher reported individual-level stressors were associated with higher incident CHD. Participants in the high individual-level stressor category had 65{\%} higher risk of incident CHD (95{\%} CI 1.23 to 2.22) than those in the low category after adjusting for sociodemographics (P for trend=0.002). This association weakened but remained significant with further adjustment for behavioural and biological risk factors. There was a non-linear relationship between neighbourhood-level stressors and incident CHD (P for quadratic term=0.01). Participants in the medium category had 49{\%} higher CHD risk (95{\%} CI 1.06 to 2.10) compared with those in the low category; those in the high category had only 27{\%} higher CHD risk (95{\%} CI 0.83 to 1.95). These associations persisted with adjustment for risk factors and individual-level stressors. Conclusions: Individual-level and neighbourhood-level stressors were independently associated with incident CHD, though the nature of the relationships differed.",
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T1 - Associations of chronic individual-level and neighbourhood-level stressors with incident coronary heart disease

T2 - The Multi-Ethnic Study of Atherosclerosis

AU - Kershaw, Kiarri N.

AU - Diez Roux, Ana V.

AU - Bertoni, Alain

AU - Carnethon, Mercedes R.

AU - Everson-Rose, Susan

AU - Liu, Kiang

PY - 2015/1/1

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N2 - Background: Several individual-level stressors have been linked to incident coronary heart disease (CHD), but less attention has focused on the influence of neighbourhood-level sources of stress. In this study we examined prospective associations of individual-level and neighbourhood-level stressors with incident CHD. Methods: Multi-Ethnic Study of Atherosclerosis participants aged 45-84 years at baseline (2000-2002) with complete data were included in the analyses (n=6678 for individual-level and n=6105 for neighbourhood-level stressors). CHD was defined as non-fatal myocardial infarction, resuscitated cardiac arrest or CHD death. Median follow-up was 10.2 years. Multivariable Cox proportional hazards models were fitted to estimate associations of individual-level and neighbourhood-level stressors (categorised into approximate tertiles) with incident CHD. Results: Higher reported individual-level stressors were associated with higher incident CHD. Participants in the high individual-level stressor category had 65% higher risk of incident CHD (95% CI 1.23 to 2.22) than those in the low category after adjusting for sociodemographics (P for trend=0.002). This association weakened but remained significant with further adjustment for behavioural and biological risk factors. There was a non-linear relationship between neighbourhood-level stressors and incident CHD (P for quadratic term=0.01). Participants in the medium category had 49% higher CHD risk (95% CI 1.06 to 2.10) compared with those in the low category; those in the high category had only 27% higher CHD risk (95% CI 0.83 to 1.95). These associations persisted with adjustment for risk factors and individual-level stressors. Conclusions: Individual-level and neighbourhood-level stressors were independently associated with incident CHD, though the nature of the relationships differed.

AB - Background: Several individual-level stressors have been linked to incident coronary heart disease (CHD), but less attention has focused on the influence of neighbourhood-level sources of stress. In this study we examined prospective associations of individual-level and neighbourhood-level stressors with incident CHD. Methods: Multi-Ethnic Study of Atherosclerosis participants aged 45-84 years at baseline (2000-2002) with complete data were included in the analyses (n=6678 for individual-level and n=6105 for neighbourhood-level stressors). CHD was defined as non-fatal myocardial infarction, resuscitated cardiac arrest or CHD death. Median follow-up was 10.2 years. Multivariable Cox proportional hazards models were fitted to estimate associations of individual-level and neighbourhood-level stressors (categorised into approximate tertiles) with incident CHD. Results: Higher reported individual-level stressors were associated with higher incident CHD. Participants in the high individual-level stressor category had 65% higher risk of incident CHD (95% CI 1.23 to 2.22) than those in the low category after adjusting for sociodemographics (P for trend=0.002). This association weakened but remained significant with further adjustment for behavioural and biological risk factors. There was a non-linear relationship between neighbourhood-level stressors and incident CHD (P for quadratic term=0.01). Participants in the medium category had 49% higher CHD risk (95% CI 1.06 to 2.10) compared with those in the low category; those in the high category had only 27% higher CHD risk (95% CI 0.83 to 1.95). These associations persisted with adjustment for risk factors and individual-level stressors. Conclusions: Individual-level and neighbourhood-level stressors were independently associated with incident CHD, though the nature of the relationships differed.

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