Neighborhood environments and coronary heart disease: A multilevel analysis

Ana V. Diez-Roux, F. Javier Nieto, Carles Muntaner, Herman A. Tyroler, George W. Comstock, Eyal Shahar, Lawton S. Cooper, Robert L. Watson, Moyses Szklo

Research output: Contribution to journalArticlepeer-review

616 Citations (Scopus)


The authors investigated whether neighborhood socioeconomic characteristics are associated with coronary heart disease prevalence and risk factors, whether these associations persist after adjustment for individual-level social class indicators, and whether the effects of individual-level indicators vary across neighborhoods. The study sample consisted of 12,601 persons in four US communities (Washington County, Maryland; Forsyth County, North Carolina; Minneapolis, Minnesota; and Jackson, Mississippi) participating in the baseline examination of the Atherosclerosis Risk in Communities Study (1987-1989). Neighborhood characteristics were obtained from 1990 US Census block-group measures. Multilevel models were used to estimate associations with neighborhood variables after adjustment for individual-level indicators of social class. Living in deprived neighborhoods was associated with increased prevalence of coronary heart disease and increased levels of risk factors, with associations generally persisting after adjustment for individual-level variables. Inconsistent associations were documented for serum cholesterol and disease prevalence in African-American men. For Jackson African-American men living in poor neighborhoods, coronary heart disease prevalence decreased as neighborhood characteristics worsened. Additionally, in African-American men from Jackson, low social class was associated with increased serum cholesterol in 'richer' neighborhoods but decreased serum cholesterol in 'poorer' neighborhoods. Neighborhood environments may be one of the pathways through which social structure shapes coronary heart disease risk.

Original languageEnglish
Pages (from-to)48-63
Number of pages16
JournalAmerican journal of epidemiology
Issue number1
Publication statusPublished - 1997 Jul 1

Bibliographical note

Funding Information:
The ARIC Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts N01-HC-55015, N01-HC-55016, N01-HC-55018, N01-HC-55019, N01-HC-55020, N01-HC-55021, and N01-HC-55022.


  • Atherosclerosis
  • Cardiovascular diseases
  • Coronary disease
  • Ethnic groups
  • Social class
  • Social conditions
  • Socioeconomic factors

ASJC Scopus subject areas

  • Epidemiology


Dive into the research topics of 'Neighborhood environments and coronary heart disease: A multilevel analysis'. Together they form a unique fingerprint.

Cite this