Chaix B, Lindström M, Rosvall M, Merlo J
Community Medicine and Public Health, Department of Clinical Sciences, Malmö University Hospital, Lund University, Malmö, Sweden.
J Epidemiol Community Health. 2008 Jan;62(1):62-8. doi: 10.1136/jech.2006.056960.
Previous studies of neighbourhood effects on ischaemic heart disease (IHD) have used census or administrative data to characterise the residential context, most commonly its socioeconomic level. Using the ecometric approach to define neighbourhood social interaction variables that may be relevant to IHD, neighbourhood social cohesion and safety were examined to see how they related to acute myocardial infarction (AMI) mortality, after adjustment for individual and neighbourhood confounders.
To construct social interaction variables, multilevel models were used to aggregate individual perceptions of safety and cohesion at the neighbourhood level. Linking data from the Health Survey in Scania, Sweden, and the Population, Hospital, and Mortality Registers, multilevel survival models were used to investigate determinants of AMI mortality over a three year and nine month period.
7791 Individuals aged 45 years and over.
The rate of AMI mortality increased with decreasing neighbourhood safety and cohesion. After adjustment for individual health and socioeconomic variables, low neighbourhood cohesion, and to a lesser extent low safety, were associated with higher AMI mortality. Neighbourhood cohesion effects persisted after adjustment for various neighbourhood confounding factors (income, population density, percentage of residents from low-income countries, residential stability) and distance to the hospital. There was some evidence that neighbourhood cohesion effects on AMI mortality were caused by effects on one-day case-fatality, rather than on incidence.
Beyond commonly evoked effects of the physical environment, neighbourhood social interaction patterns may have a decisive influence on IHD, with a particularly strong effect on survival after AMI.
以往关于邻里环境对缺血性心脏病（IHD）影响的研究使用人口普查或行政数据来描述居住环境，最常见的是其社会经济水平。采用生态计量方法定义可能与IHD相关的邻里社会互动变量，在对个体和邻里混杂因素进行调整后，研究邻里社会凝聚力和安全性与急性心肌梗死（AMI）死亡率之间的关系。
为构建社会互动变量，使用多层次模型汇总邻里层面个体对安全性和凝聚力的感知。将瑞典斯科讷地区健康调查数据与人口、医院和死亡率登记数据相链接，使用多层次生存模型研究三年零九个月期间AMI死亡率的决定因素。
7791名年龄在45岁及以上的个体。
AMI死亡率随着邻里安全性和凝聚力的降低而上升。在对个体健康和社会经济变量进行调整后，邻里凝聚力低以及在较小程度上安全性低与较高的AMI死亡率相关。在对各种邻里混杂因素（收入、人口密度、来自低收入国家居民的百分比、居住稳定性）和到医院的距离进行调整后，邻里凝聚力的影响依然存在。有证据表明，邻里凝聚力对AMI死亡率的影响是通过对一日病死率而非发病率的影响造成的。
除了通常提到的物理环境影响外，邻里社会互动模式可能对缺血性心脏病有决定性影响，对AMI后的生存影响尤为强烈。
