Jeffrey J Wing1, Ella August2, Sara D Adar2, Andrew L Dannenberg2, Anjum Hajat2, Brisa N Sánchez2, James H Stein2, Matthew C Tattersall2, Ana V Diez Roux2. 1. From Department of Public Health, Grand Valley State University, Grand Rapids, MI (J.J.W.); Departments of Epidemiology (E.A., S.D.A.) and Biostatistics (B.S.), University of Michigan School of Public Health, Ann Arbor; Departments of Environmental and Occupational Health Sciences (A.L.D.) and Epidemiology (A.H.), University of Washington School of Public Health, Seattle; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (J.H.S., M.C.T.); and Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University School of Public Health, Philadelphia, PA (A.V.D.R.). wingje@gvsu.edu. 2. From Department of Public Health, Grand Valley State University, Grand Rapids, MI (J.J.W.); Departments of Epidemiology (E.A., S.D.A.) and Biostatistics (B.S.), University of Michigan School of Public Health, Ann Arbor; Departments of Environmental and Occupational Health Sciences (A.L.D.) and Epidemiology (A.H.), University of Washington School of Public Health, Seattle; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (J.H.S., M.C.T.); and Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University School of Public Health, Philadelphia, PA (A.V.D.R.).
Abstract
BACKGROUND: Although some evidence shows that neighborhood deprivation is associated with greater subclinical atherosclerosis, prior studies have not identified what aspects of deprived neighborhoods were driving the association. METHODS: We investigated whether social and physical neighborhood characteristics are related to the progression of subclinical atherosclerosis in 5950 adult participants of the MESA (Multi-Ethnic Study of Atherosclerosis) during a 12-year follow-up period. We assessed subclinical disease using coronary artery calcium (CAC). Neighborhood features examined included density of recreational facilities, density of healthy food stores, and survey-based measures of availability of healthy foods, walking environment, and social environment. We used econometric fixed-effects models to investigate how change in a given neighborhood exposure is related to simultaneous change in subclinical atherosclerosis. RESULTS: Increases in density of neighborhood healthy food stores were associated with decreases in CAC (mean changes in CAC Agatston units per 1-SD increase in neighborhood exposures, -19.99; 95% confidence interval, -35.21 to -4.78) after adjustment for time-varying demographic confounders and computed tomography scanner type. This association remained similar in magnitude after additional adjustment for time-varying behavioral risk factors and depression. The addition of time-varying biomedical factors attenuated associations with CAC slightly (mean changes in CAC per 1-SD increase in neighborhood exposures, -17.60; 95% confidence interval, -32.71 to -2.49). Changes across time in other neighborhood measures were not significantly associated with within-person change in CAC. CONCLUSIONS: Results from this longitudinal study provide suggestive evidence that greater access to neighborhood healthy food resources may slow the development of coronary atherosclerosis in middle-aged and older adults.
BACKGROUND: Although some evidence shows that neighborhood deprivation is associated with greater subclinical atherosclerosis, prior studies have not identified what aspects of deprived neighborhoods were driving the association. METHODS: We investigated whether social and physical neighborhood characteristics are related to the progression of subclinical atherosclerosis in 5950 adult participants of the MESA (Multi-Ethnic Study of Atherosclerosis) during a 12-year follow-up period. We assessed subclinical disease using coronary artery calcium (CAC). Neighborhood features examined included density of recreational facilities, density of healthy food stores, and survey-based measures of availability of healthy foods, walking environment, and social environment. We used econometric fixed-effects models to investigate how change in a given neighborhood exposure is related to simultaneous change in subclinical atherosclerosis. RESULTS: Increases in density of neighborhood healthy food stores were associated with decreases in CAC (mean changes in CAC Agatston units per 1-SD increase in neighborhood exposures, -19.99; 95% confidence interval, -35.21 to -4.78) after adjustment for time-varying demographic confounders and computed tomography scanner type. This association remained similar in magnitude after additional adjustment for time-varying behavioral risk factors and depression. The addition of time-varying biomedical factors attenuated associations with CAC slightly (mean changes in CAC per 1-SD increase in neighborhood exposures, -17.60; 95% confidence interval, -32.71 to -2.49). Changes across time in other neighborhood measures were not significantly associated with within-person change in CAC. CONCLUSIONS: Results from this longitudinal study provide suggestive evidence that greater access to neighborhood healthy food resources may slow the development of coronary atherosclerosis in middle-aged and older adults.
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