摘要：Objectives. We examined associations between cardiovascular disease and neighborhood psychosocial hazards, such as violent crime, abandoned buildings, and signs of incivility, to evaluate whether features of place are associated with older adult health. Methods. We analyzed first-visit data from the Baltimore Memory Study of randomly selected residents aged 50 to 70 years (n=1140) of 65 contiguous neighborhoods in Baltimore, Maryland. We looked for associations between self-reports of history of selected cardiovascular diseases and scores on the 12-item neighborhood psychosocial hazards scale. Results. After adjustment for established individual risk factors for cardiovascular disease, residents in neighborhoods with scores in the highest quartile of the psychosocial hazards scale had more than 4 times higher odds of a history of myocardial infarction and more than 3 times higher odds of myocardial infarction, stroke, transient ischemic attack, or intermittent claudication compared with residents living in neighborhoods scoring in the lowest quartile. Conclusions. Neighborhood psychosocial hazards were significantly associated with self-reported cardiovascular disease after adjustment for individual-level risk factors. This is consistent with the hypothesis that environmental stress plays a role in the etiology of cardiovascular disease. The effect on health of the places in which people live—apart from individual, genetic, or lifestyle characteristics—is of increasing interest to researchers. 1 A new wave of research is examining the health consequences of various aspects of residential neighborhoods. Moving beyond the study of individual risk factors to the study of neighborhoods may be a key to understanding widening health disparities across racial/ethnic and sociodemographic groups. 2 , 3 Many aspects of neighborhoods are hypothesized to influence cardiovascular disease (CVD) risk through several different and potentially interrelated mechanisms. 4 – 6 Health behavior has received significant attention. Some data suggest that residents of socioeconomically deprived neighborhoods are more likely to engage in high-risk health behaviors, including inactivity, 7 , 8 poor diet, 9 illicit drug use, 10 , 11 and smoking. 12 However, studies that found an association between neighborhood of residence and CVD after adjustment for many of these health behaviors raised doubts that behavior was the sole mechanism. 13 , 14 Several studies have examined the relationship between neighborhood socioeconomic characteristics (such as percentage of residents living in poverty) and CVD. Living in disadvantaged neighborhoods was found to be independently associated with increased risk of subclinical CVD, 15 coronary heart disease, 13 , 16 and stroke, 17 as well as poorer prognosis and decreased survival after myocardial infarction. 18 Several explanations have been suggested for this association. 4 Psychosocial hazards in the neighborhood may be an important link between neighborhood socioeconomic disadvantage and adverse health outcomes. 5 , 19 Psychosocial hazards are visible characteristics of neighborhoods—such as violent crime, abandoned buildings, and signs of incivility—that give rise to a heightened state of vigilance, alarm, or threat. 6 , 20 Daily exposure to psychosocial hazards in the neighborhood is known to activate a physiological stress response. 21 , 22 Chronic stress may in turn lead to dysregulation of either the autonomic nervous system 23 or the hypothalamic–pituitary–adrenal axis, or both. Dysregulation of the latter has been linked to key CVD risk factors, including the deposition of abdominal fat, 24 , 25 acute and chronic elevations in blood pressure, 26 and various inflammatory processes. 27 We tested the hypothesis that a higher level of neighborhood psychosocial hazards is associated with increased odds of self-reported myocardial infarction, stroke, transient ischemic attack, and intermittent claudication, independent of individual-level risk factors.
