Impact of neighborhood resources on cardiovascular disease: a nationwide six-year follow-up.

BACKGROUND: Living in a socially deprived neighborhood is associated with lifestyle risk factors, e.g., smoking, physical inactivity and unhealthy diet, as well as an increased risk of cardiovascular disease, i.e., coronary heart disease and stroke. The aim was to study whether the odds of cardiovascular disease vary with the neighbourhood availability of potentially health-damaging and health-promoting resources. METHODS: A nationwide sample of 2 040 826 men and 2 153 426 women aged 35-80 years were followed for six years for first hospitalization of coronary heart disease or stroke. Neighborhood availability of health-damaging resources (i.e., fast-food restaurants and bars/pubs) and health-promoting resources (i.e., health care facilities and physical activity facilities) were determined by use of geographic information systems (GIS). RESULTS: We found small or modestly increased odds ratios (ORs) for both coronary heart disease and stroke, related to the availability of both health-damaging and health-promoting resources. For example, in women, the unadjusted OR (95 % confidence interval) for stroke in relation to availability of fast-food restaurants was 1.18 (1.15-1.21). Similar patterns were observed in men, with an OR = 1.08 (1.05-1.10). However, the associations became weaker or disappeared after adjustment for neighborhood-level deprivation and individual-level age and income. CONCLUSIONS: This six year follow-up study shows that neighborhood availability of potentially health-damaging as well as health-promoting resources may make a small contribution to the risk of coronary heart disease and stroke. However, most of these associations were attenuated or disappeared after adjustment for neighborhood-level deprivation and individual-level age and income. Future studies are needed to further examine factors in the causal pathway between neighborhood deprivation and cardiovascular disease.

Neighborhood linking social capital as a predictor of psychiatric medication prescription in the elderly: a Swedish national cohort study.

OBJECTIVES: Little is known about the association between neighborhood linking social capital and psychiatric medication in the elderly. The present study analyzes whether there is an association between linking social capital (a theoretical concept describing the amount of trust between individuals and societal institutions) and prescription of antipsychotics, anxiolytics, hypnotics/sedatives, antidepressants, or anti-dementia drugs. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: The entire Swedish population aged 65+, a total of 1,292,816 individuals, were followed from 1 July 2005 until first prescription of psychiatric medication, death, emigration, or the end of the study on 31 December 2010. Small geographic units were used to define neighborhoods. The definition of linking social capital was based on mean voting participation in each neighborhood unit, categorized in three groups. Multilevel logistic regression was used to estimate odds ratios (ORs) and between-neighborhood variance in three different models. RESULTS: There was an inverse association between the level of linking social capital and prescription of psychiatric medications (except for anti-dementia drugs). The associations decreased, but remained significant, after accounting for age, sex, family income, marital status, country of birth, and education level (except for antidepressants). The OR for prescription of antipsychotics in the crude model was 1.65 (95% CI 1.53-1.78) and decreased, but remained significant (OR = 1.26; 95% CI 1.17-1.35), after adjustment for the individual-level sociodemographic variables. CONCLUSIONS: Decision-makers should take into account the potentially negative effect of linking social capital on psychiatric disorders when planning sites of primary care centers and psychiatric clinics, as well as other kinds of community support for elderly patients with such disorders.

Linking social capital and mortality in the elderly: a Swedish national cohort study.

OBJECTIVES: Our objective was to examine the association between neighborhood linking social capital (a concept describing the amount of trust between individuals and societal institutions) and all-cause and cause-specific mortality in the elderly. DESIGN: The entire Swedish population aged 65+, a total of 1,517,336 men and women, was followed from 1 January 2002 until death, emigration, or the end of the study on 31 December 2010. Small geographic units were used to define neighborhoods. The definition of linking social capital was based on neighborhood voting participation rates, categorized into three groups. Multilevel logistic regression was used to estimate odds ratios (ORs) and between-neighborhood variance in three different models. RESULTS: The results showed an overall association between linking social capital and all-cause mortality. The significant OR of 1.53 in the group with low linking social capital decreased, but remained significant (OR=1.27), after accounting for age, sex, family income, marital status, country of birth, education level, and region of residence. There were also significant associations between linking social capital and cause-specific mortality in coronary heart disease, psychiatric disorders, cancer, stroke, chronic lower respiratory diseases, type 2 diabetes, and suicide. CONCLUSION: There are associations between low linking social capital and mortality from chronic disorders and suicide in the elderly population. Community support for elderly people living in neighborhoods with low levels of linking social capital may need to be strengthened.

Neighbourhood environment and stroke: a follow-up study in Sweden.

BACKGROUND: In recent years, research on the association between physical environments and cardiovascular disease outcomes has gained momentum with growing attention being paid to Geographic Information Systems (GIS). This nationwide study is the first to examine the effect of neighbourhood physical environments on individual-level stroke, using GIS-based measures of neighbourhood availability of potentially health-damaging (fast food restaurants and pubs/bars) and health-promoting (physical activity and healthcare) resources. METHODS: The study population comprised a nationwide sample of 2,115,974 men and 2,193,700 women aged 35-80 years who were followed between 1 December 2005 and 31 December 2007 in Sweden. Totally 42,270 first-ever strokes (both morbidity and mortality) were identified. Multilevel logistic regression models were used to estimate the association between neighbourhood availability of four different resources (fast food restaurants, pubs/bars, physical activity and healthcare) and individual-level stroke. PRINCIPAL FINDINGS: There were significant associations between neighbourhood availability of the four types of neighbourhood resources and individual-level stroke. The significant odds ratios varied between 1.06 and 1.12 for men and 1.07 and 1.24 for women. After adjustment for age, income, and neighbourhood-level deprivation, the increased odds remained statistically significant for neighbourhood availability of fast food restaurants in both men and women. CONCLUSIONS: Specific neighbourhood availability of resources were associated with individual-level stroke but most of these associations were explained by individual-level sociodemographic factors and neighbourhood-level deprivation.

Physical activity and concordance between objective and perceived walkability.

PURPOSE: The study's purpose was to investigate concordance between objective and perceived neighborhood walkability, their associations with self-reported walking and objective physical activity, and sociodemographic characteristics of individuals in neighborhoods with objectively assessed high walkability who misperceive it as low. METHODS: In 1925 individuals age 20-66 yr of both high and low neighborhood walkability recruited from administrative areas in the city of Stockholm, Sweden, objective neighborhood walkability was assessed within a 1000-m radius of each individual's residential address using geographic information systems. Perceived walkability was based on the Neighborhood Environment Walkability Scale. Walking was assessed using the International Physical Activity Questionnaire, and total physical activity and moderate-to-vigorous physical activity (MVPA) were assessed by an accelerometer (ActiGraph). Sociodemographic characteristics were self-reported. RESULTS: Objective and perceived neighborhood walkability agreed in 67.0% of the individuals, with κ = 0.34 (95% confidence interval (CI) = 0.30-0.38). One-third of the individuals in neighborhoods with objectively assessed high walkability misperceived it as low. This nonconcordance was more common among older and married/cohabiting individuals. After adjustment for sociodemographic characteristics, high objective neighborhood walkability was associated with 35.0 (95% CI = 14.6-64.6) and 10.5 (95% CI = -5.2 to 28.5) more minutes per week of walking for transportation and leisure, respectively, and 2.8 (95% CI = 0.9-5.0) more minutes per day of MVPA. High perceived neighborhood walkability was associated with 41.5 (95% CI = 15.8-62.9) and 21.8 (95% CI = 2.8-40.0) more minutes per week of walking for transportation and leisure, respectively, and 1.7 (95% CI = -0.3 to 3.7) more minutes per day of MVPA. CONCLUSIONS: Objective and perceived neighborhood walkability both contribute to the amount of walking and objective physical activity. Both measures of neighborhood walkability may be important factors to target in interventions aiming at increasing physical activity.

Neighborhood walkability, physical activity, and walking behavior: the Swedish Neighborhood and Physical Activity (SNAP) study.

More knowledge concerning the association between physical activity and objectively measured attributes of the built environment is needed. Previous studies on the association between objectively measured neighborhood walkability, physical activity, and walking have been conducted in the U.S. or Australia and research findings are available from only one country in Europe - Belgium. The first aim of this Swedish study of 2269 adults was to examine the associations between neighborhood walkability and walking for active transportation or leisure, and moderate-to-vigorous physical activity (MVPA) and whether these hypothesized associations are moderated by age, gender, income, marital status and neighborhood-level socioeconomic status. The second aim was to determine how much of the total variance of the walking and physical activity outcomes can be attributed to neighborhood-level differences. Neighborhood walkability was objectively measured by GIS methods. An index consisting of residential density, street connectivity, and land use mix was constructed to define 32 highly and less walkable neighborhoods in Stockholm City. MVPA was measured objectively during 7 days with an accelerometer and walking was assessed using the validated International Physical Activity Questionnaire (IPAQ). Multilevel linear as well as logistic models (mixed-effects, mixed-distribution models) were used in the analysis. The statistically significant and "adjusted" results for individuals living in highly walkable neighborhoods, as compared to those living in less walkable neighborhoods, were: (1) 77% and 28% higher odds for walking for active transportation and walking for leisure, respectively, (2) 50 min more walking for active transportation/week, and (3) 3.1 min more MVPA/day. The proportion of the total variance at the neighborhood level was low and ranged between 0.0% and 2.1% in the adjusted models. The findings of the present study stress that future policies concerning the built environment must be based on context-specific evidence, particularly in the light of the fact that neighborhood redevelopments are time-consuming and expensive.

Health-promoting and health-damaging neighbourhood resources and coronary heart disease: a follow-up study of 2 165 000 people.

BACKGROUND: It has been hypothesised that the presence of health-damaging factors and lack of health-promoting factors lie in the causal pathway between neighbourhood deprivation and coronary heart disease (CHD). This study is the first to examine the associations between individual-level CHD risk and neighbourhood availability of fast-food restaurants, bars/pubs, physical activity facilities and healthcare resources. METHODS: Multilevel logistic regression models were used for the follow-up of 1 065 000 men and 1 100 000 women (aged 35-80 years) between 1 December 2005 and 31 December 2007, for individual-level CHD events (both morbidity and mortality). RESULTS: The relatively weak associations between neighbourhood availability of potentially health-damaging and health-promoting goods, services and resources, and CHD incidence no longer remained significant after adjustment for neighbourhood-level deprivation and individual-level age and income. CONCLUSIONS: The presence of potentially health-damaging factors and lack of potentially health-promoting factors do not seem to contribute significantly to the development of CHD. Other features of deprived neighbourhoods appear to play a greater role.

Differences in neighborhood accessibility to health-related resources: a nationwide comparison between deprived and affluent neighborhoods in Sweden.

This nationwide Swedish study used geocoded data from all businesses in Sweden to examine the distribution of 12 main categories of goods, services, and resources in 6986 neighborhoods, categorized as low, moderate, and high neighborhood deprivation. The main findings were that high- and moderate-deprivation neighborhoods had a significantly higher prevalence of all types of goods, services, and resources than low-deprivation neighborhoods. These findings do not support previous research that hypothesizes that poorer health among people in deprived neighborhoods is explained by a lack of health-promoting resources, although a higher presence of health-damaging resources may play a role.

Age dependency of esterase activity in rat and human keratinocytes.

The age and species dependent characteristics of cutaneous esterase activity were examined in cultured keratinocytes of neonatal and adult humans and of rats at the age of 1, 3, 10, and 50 d. The existence of esterases was characterized using fluorescein-5-isothiocyanate diacetate under a confocal laser scanning microscope. In vitro hydrolysis of ethyl nicotinate (EN), an esterified prodrug of nicotinic acid, was investigated in homogenate of cultured keratinocytes, and the Michaelis-Menten parameters (V(max) and K(m)) of EN were evaluated. Together with development and growth of rats and humans, V(max) and V(max)/K(m) increased drastically, suggesting that esterases in keratinocytes develop markedly during the growth process. The affinity parameter, K(m), was almost the same among the ages in each species. These findings in cultured keratinocytes corresponded with our previous report using dissected skin specimens. Species differences in V(max), V(max)/K(m) and K(m) were also observed, and these parameters of EN hydrolysis in rats were significantly higher than that in humans. In conclusion, cultured keratinocytes can be an advantageous method with which to estimate cutaneous activation of ester prodrugs in humans and during the growth process.