Tamura Kosuke, Deng Yangyang, Rogers Breanna, Moniruzzaman Mohammad, Jagannathan Ram, Hu Lu, Miura Katsuyuki, Roger Véronique L, Mariño-Ramírez Leonardo
Socio-Spatial Determinants of Health (SSDH) Laboratory, Population and Community Health Sciences Branch, Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
Socio-Spatial Determinants of Health (SSDH) Laboratory, Population and Community Health Sciences Branch, Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA.
Open Heart. 2025 May 27;12(1):e003225. doi: 10.1136/openhrt-2025-003225.
To examine the associations of deprived neighbourhoods with all-cause mortality and incident cardiovascular disease (CVD) and to investigate whether these associations were independently and concurrently stratified by sex and ethnicity.
Data came from the UK Biobank, a prospective cohort study of over 500 000 participants aged 22-69 across the UK between 2006 and 2010. The follow-up time was calculated from each participant's enrolment at baseline until the first occurrence of a diagnosis of each death, incident or the censor date (31 December 2020). All-cause mortality, incident total CVD, ischaemic heart disease (IHD) and cerebrovascular disease (CeVD) were the outcomes defined based on the International Classification of Diseases. Deprived neighbourhoods were categorised into four groups: least deprived (referent), somewhat deprived, deprived, and most deprived neighbourhoods. Cox proportional hazards models were used to examine associations of deprived neighbourhoods with each outcome. Analyses were stratified by sex and ethnicity separately and simultaneously.
A total of 261 954 participants were included. Participants had a mean follow-up of 14.3 years for all-cause mortality (3 745 307 person-years, 9933 deaths) and 12.7 years for total CVD incidence (3 321 619 person-years, 64 748 events). Those in the most deprived neighbourhoods (compared with the least) had a 31%, 13%, 15% and 34% greater risk of all-cause mortality, incident total CVD, IHD and CeVD, respectively. Patterns of associations were somewhat similar by sex, yet varied by ethnicity. The overall results were consistent with the white cohort but not for the other cohorts.
This study indicated that individuals living in highly deprived neighbourhoods may have an elevated risk of all-cause mortality and incident CVD, particularly among the white cohort but not other cohorts. Future research should focus on efforts to invest in deprived areas to alleviate the burden of all-cause mortality and CVD incidence.
研究贫困社区与全因死亡率及心血管疾病（CVD）发病之间的关联，并调查这些关联是否按性别和种族进行独立及同时分层。
数据来自英国生物银行，这是一项对2006年至2010年间英国50多万名年龄在22至69岁之间的参与者进行的前瞻性队列研究。随访时间从每位参与者在基线时入组开始计算，直至首次出现死亡、发病诊断或审查日期（2020年12月31日）。全因死亡率、CVD总发病率、缺血性心脏病（IHD）和脑血管疾病（CeVD）是根据《国际疾病分类》定义的结局。贫困社区分为四组：最不贫困（参照组）、有些贫困、贫困和最贫困社区。采用Cox比例风险模型研究贫困社区与各结局之间的关联。分析分别按性别和种族进行分层，同时也进行了综合分层。
共纳入261954名参与者。参与者全因死亡率的平均随访时间为14.3年（3745307人年，9933例死亡），CVD总发病率的平均随访时间为12.7年（3321619人年，64748例事件）。最贫困社区的居民（与最不贫困社区相比）全因死亡率、CVD总发病率、IHD和CeVD的风险分别高31%、13%、15%和34%。关联模式在性别上有些相似，但在种族上有所不同。总体结果与白人队列一致，但与其他队列不一致。
本研究表明，生活在高度贫困社区的个体全因死亡率和CVD发病风险可能会升高，尤其是在白人队列中，但在其他队列中并非如此。未来的研究应致力于对贫困地区进行投资，以减轻全因死亡率和CVD发病率的负担。
