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Journal of the American Heart Association
Oct, 2024;13 (19): e036511.

Association Between Neighborhood-Level Income and the Incidence of Cardiovascular Events Varies by Immigration Status: A Population-Based Cohort Study.

Manav V Vyas, Hibo Rijal, Amy Y X Yu, Peter C Austin, Anna Chu, Maria Santiago-Jimenez, Jiming Fang, Nadia A Khan, Husam M Abdel-Qadir, Moira K Kapral
Author Information
  1. Manav V Vyas: Division of Neurology, Department of Medicine University of Toronto Canada. ORCID
  2. Hibo Rijal: ICES Toronto Ontario Canada.
  3. Amy Y X Yu: Division of Neurology, Department of Medicine University of Toronto Canada. ORCID
  4. Peter C Austin: Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health University of Toronto Canada. ORCID
  5. Anna Chu: ICES Toronto Ontario Canada. ORCID
  6. Maria Santiago-Jimenez: ICES Toronto Ontario Canada. ORCID
  7. Jiming Fang: ICES Toronto Ontario Canada. ORCID
  8. Nadia A Khan: Division of General Internal Medicine, Department of Medicine, Center for Advancing Health Outcomes University of British Columbia Vancouver Canada.
  9. Husam M Abdel-Qadir: Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health University of Toronto Canada. ORCID
  10. Moira K Kapral: Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health University of Toronto Canada. ORCID
PMID: 39344632 DOI: 10.1161/JAHA.124.036511

Abstract

BACKGROUND: Neighborhood-level income is inversely associated with cardiovascular events; however, it is uncertain whether this association varies with immigration status.
METHODS AND RESULTS: We conducted a population-based cohort study of 5.2 million (53% women, 19% immigrants) urban-dwelling people aged ≥40 years without a prior history of cardiovascular disease in Ontario, Canada. Neighborhood-level income was measured in quintiles from quintile 1 (lowest) to quintile 5 (highest), and immigrants were defined as those born outside of Canada who moved to Canada after 1985. We estimated the association between neighborhood-level income and the rate of incident cardiovascular events (hospitalization for stroke or myocardial infarction, or cardiovascular death) using multivariable cause-specific hazards models and added an interaction term to see if the association varies by immigration status. The absolute difference in the rate of cardiovascular events across income quintiles was less pronounced in immigrants than in long-term residents: age- and sex-adjusted rate per 1000 person-years in quintile 1 versus quintile 5: 5.69 versus 4.10 in immigrants and 8.37 versus 5.87 in long-term residents. In adjusted models, the interaction between immigration status and neighborhoodl evel was significant ( <0.001). The hazard of cardiovascular events declined with increasing income among long-term residents (hazard ratio [HR], 1.46 to HR, 1.10) and immigrants, albeit with a smaller gradient (HR, 1.43 to HR, 1.20).
CONCLUSIONS: The association between neighborhood-level income and cardiovascular disease incidence varies by immigration status. Understanding the social and structural factors associated with residing in low-income neighborhoods can help with the development of prevention programs that improve health for all.

Keywords

cardiovascular events immigrants myocardial infarction neighborhood‐level income stroke

References

Can J Cardiol. 2016 Dec;32(12):1561-1565 [PMID: 27742459]
Circulation. 2015 Aug 31;132(16):1549–1559 [PMID: 26324719]
ANS Adv Nurs Sci. 2020 Oct/Dec;43(4):375-390 [PMID: 32956090]
N Engl J Med. 2001 Jul 12;345(2):99-106 [PMID: 11450679]
Prev Med. 1991 Mar;20(2):250-61 [PMID: 2057471]
Int J Addict. 1986 Sep-Oct;21(9-10):961-76 [PMID: 3793315]
Occup Environ Med. 2014 Mar;71(3):183-8 [PMID: 24401871]
Can J Public Health. 2022 Apr;113(2):260-271 [PMID: 34432255]
Lancet Glob Health. 2019 Jun;7(6):e748-e760 [PMID: 31028013]
Circulation. 2018 May 15;137(20):2166-2178 [PMID: 29760227]
Am J Public Health. 2008 Feb;98(2):216-21 [PMID: 18172133]
Soc Sci Med. 2017 Sep;188:60-68 [PMID: 28732236]
Circulation. 2022 Jul 19;146(3):229-239 [PMID: 35861763]
J Epidemiol Community Health. 2019 Apr;73(4):287-294 [PMID: 30696690]
Ann Behav Med. 2019 Aug 16;53(9):858-864 [PMID: 30395158]
COPD. 2009 Oct;6(5):388-94 [PMID: 19863368]
J Epidemiol Community Health. 2001 Feb;55(2):111-22 [PMID: 11154250]
CMAJ. 2008 May 20;178(11):1429-35 [PMID: 18490638]
N Engl J Med. 1999 Oct 28;341(18):1359-67 [PMID: 10536129]
J Epidemiol Community Health. 2004 Jan;58(1):71-7 [PMID: 14684730]
J Clin Epidemiol. 2004 Mar;57(3):229-36 [PMID: 15066682]
Am Heart J. 2002 Aug;144(2):290-6 [PMID: 12177647]
Can J Neurol Sci. 2016 Nov;43(6):765-773 [PMID: 27426016]
Neurology. 2012 Sep 18;79(12):1200-7 [PMID: 22895592]
BMC Geriatr. 2023 Jun 21;23(1):380 [PMID: 37344785]
Lancet. 1984 Jun 30;1(8392):1455-7 [PMID: 6145889]
BMC Health Serv Res. 2015 Apr 09;15:146 [PMID: 25888912]
Lancet. 2018 Dec 15;392(10164):2553-2566 [PMID: 30528484]
Neurology. 2016 Nov 29;87(22):2340-2347 [PMID: 27742815]
Circ Cardiovasc Qual Outcomes. 2015 Mar;8(2):204-12 [PMID: 25648464]
Med Sci Sports Exerc. 1992 Jun;24(6 Suppl):S221-36 [PMID: 1625548]
Diabetes Care. 2002 Mar;25(3):512-6 [PMID: 11874939]

MeSH Term

Humans
Female
Male
Incidence
Middle Aged
Ontario
Income
Cardiovascular Diseases
Aged
Adult
Emigrants and Immigrants
Neighborhood Characteristics
Residence Characteristics
Risk Factors
Social Determinants of Health
Myocardial Infarction
Risk Assessment
Time Factors
Journal Article

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