Journal article
Unequal Exposure or Unequal Vulnerability? Contributions of Neighborhood Conditions and Cardiovascular Risk Factors to Socioeconomic Inequality in Incident Cardiovascular Disease in the Multi-Ethnic Study of Atherosclerosis
American journal of epidemiology, v 187(7), pp 1424-1437
01 Jul 2018
PMID: 29186311
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Risk factors can drive socioeconomic inequalities in cardiovascular disease (CVD) through differential exposure and differential vulnerability. In this paper, we show how econometric decomposition directly enables simultaneous, policy-oriented assessment of these 2 mechanisms. We specifically estimate contributions of neighborhood environment and proximal risk factors to socioeconomic inequality in CVD incidence via these mechanisms. We followed 5,608 participants in the Multi-Ethnic Study of Atherosclerosis (2000-2012) to their first CVD event (median length of follow-up, 12.2 years). We used a summary measure of baseline socioeconomic position (SEP). Covariates included baseline demographics, neighborhood characteristics, and psychosocial, behavioral, and biomedical risk factors. Using Poisson models, we decomposed the difference (inequality) in incidence rates between low- and high-SEP groups into contributions of 1) differences in covariate means (differential exposure) and 2) differences in CVD risk associated with covariates (differential vulnerability). Notwithstanding large uncertainty in neighborhood estimates, our analysis suggested that differential exposure to poorer neighborhood socioeconomic conditions, adverse social environment, diabetes, and hypertension accounted for most of the inequality. Psychosocial and behavioral contributions were negligible. Further, neighborhood SEP, female sex, and white race were more strongly associated with CVD among low-SEP (vs. high-SEP) participants. These differentials in vulnerability also accounted for nontrivial portions of the inequality and could have important implications for intervention.
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Details
- Title
- Unequal Exposure or Unequal Vulnerability? Contributions of Neighborhood Conditions and Cardiovascular Risk Factors to Socioeconomic Inequality in Incident Cardiovascular Disease in the Multi-Ethnic Study of Atherosclerosis
- Creators
- Mustafa Hussein - University of Wisconsin–MilwaukeeAna V Diez Roux - Drexel UniversityMahasin S Mujahid - University of California, BerkeleyTheresa A Hastert - Karmanos Cancer InstituteKiarri N Kershaw - Northwestern UniversityAlain G Bertoni - Wake Forest UniversityAna Baylin - University of Michigan–Ann Arbor
- Publication Details
- American journal of epidemiology, v 187(7), pp 1424-1437
- Publisher
- Oxford University Press
- Grant note
- N01HC95159 / NHLBI NIH HHS R01 HL071759 / NHLBI NIH HHS N01HC95169 / NHLBI NIH HHS P60 MD002249 / NIMHD NIH HHS
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Urban Health Collaborative
- Web of Science ID
- WOS:000438278100010
- Scopus ID
- 2-s2.0-85051436985
- Other Identifier
- 991019238706704721
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- Web of Science research areas
- Public, Environmental & Occupational Health