Background: Previous studies have provided justification for more detailed investigations of causal mechanisms behind the neighborhood effect on coronary heart disease (CHD). Objectives: To further our understanding of specific neighborhood effects on CHD-related outcomes in a life-course perspective, improve knowledge of causal mechanisms, and provide a more robust basis for policy interventions and health promotion via an integrated genetics and environmental cross-disciplinary approach.
Specific aims : To examine the accumulated impact of neighborhood social environments (e.g., neighborhood affluence/deprivation, neighborhood safety/criminality, social capital) and neighborhood physical environments (using objective measures of neighborhood goods, services, and resources) over time on incident CHD as well as metabolic and behavioral CHD risk factors. To examine mediators and effect modifiers in population subgroups. To examine gene-environment interactions between genetic variants (SNPs) in relation to incident CHD and CHD risk factors and neighborhood-level social and physical environments. Design/methods: We will use two new databases, the Geographic Information System (GIS)-Environment Database and the Coronary Risk Database, that are based on comprehensive datasets from multiple nationwide sources in Sweden. This will allow us to assess cumulative neighborhood exposures beginning in 1970 for: 1) the entire Swedish population, and 2) population-based cohorts (including biobanks and genetic data);and conduct follow-up analyses of CHD-related outcomes until 2016. Our new Coronary Risk Database contains nationwide data on 11.8 million men and women whose neighborhoods of residence are geocoded;the new GIS- Environment Database contains historical and current information on more than 250,000 geocoded goods, services and resources in all of Sweden. All persons in Sweden have a personal identification number that has been replaced by a serial number and used to construct the databases by linking census data, neighborhood- level social and physical environmental records, cause of death records, inpatient and outpatient hospital records, and all prescription medicine records. CHD diagnoses are available beginning in 1985 (inpatient) and 2001 (outpatient), and individual- and neighborhood-level factors beginning in 1970. We will account for individual mobility and neighborhood change over time by using latent class growth modeling and marginal structural models. We will use propensity score matching and family-based designs to control for selective migration and thereby improve the ability to determine causality compared to previous research. Furthermore, we will produce refined assessments of neighborhood exposures from advanced GIS analytic techniques and study interactions between common genetic variants (SNPs) and neighborhood social and physical environments that may influence CHD, the latter by using an exploratory Environment-Wide Association Study.

Public Health Relevance

This project will increase knowledge about how social and physical neighborhood exposures influence coronary heart disease (CHD) risk in different population groups and across different stages of life. It will use an integrated genetics and environmental cross-disciplinary approach to further the understanding of specific neighborhood effects on CHD-related outcomes and provide a more robust basis for policy interventions and health promotion.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
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Special Emphasis Panel (SSPB)
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Wright, Jacqueline
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Lund University
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Crump, C; Sundquist, J; Winkleby, M A et al. (2017) Interactive effects of obesity and physical fitness on risk of ischemic heart disease. Int J Obes (Lond) 41:255-261
Wändell, Per; Carlsson, Axel C; Li, Xinjun et al. (2017) Atrial fibrillation in immigrant groups: a cohort study of all adults 45 years of age and older in Sweden. Eur J Epidemiol 32:785-796
Wändell, Per; Carlsson, Axel C; Holzmann, Martin J et al. (2017) Comparison of Mortality and Nonfatal Cardiovascular Events in Adults With Atrial Fibrillation With Versus Without Levothyroxine Treatment. Am J Cardiol 120:1974-1979
Crump, Casey; Sundquist, Jan; Winkleby, Marilyn A et al. (2017) Interactive Effects of Aerobic Fitness, Strength, and Obesity on Mortality in Men. Am J Prev Med 52:353-361
Hamano, Tsuyoshi; Shiotani, Yoshiya; Takeda, Miwako et al. (2017) Is the Effect of Body Mass Index on Hypertension Modified by the Elevation? A Cross-Sectional Study of Rural Areas in Japan. Int J Environ Res Public Health 14:
Zöller, Bengt; Ohlsson, Henrik; Sundquist, Jan et al. (2017) Cardiovascular fitness in young males and risk of unprovoked venous thromboembolism in adulthood. Ann Med 49:176-184
Wändell, Per; Carlsson, Axel C; Holzmann, Martin et al. (2017) Association between antithrombotic treatment and hemorrhagic stroke in patients with atrial fibrillation-a cohort study in primary care. Eur J Clin Pharmacol 73:215-221
Crump, Casey; Sundquist, Jan; Winkleby, Marilyn A et al. (2017) Height, weight, and aerobic fitness in relation to risk of atrial fibrillation. Am J Epidemiol :
Martinsson, Andreas; Li, Xinjun; Zöller, Bengt et al. (2017) Familial Aggregation of Aortic Valvular Stenosis: A Nationwide Study of Sibling Risk. Circ Cardiovasc Genet 10:
Calling, Susanna; Li, Xinjun; Kawakami, Naomi et al. (2016) Impact of neighborhood resources on cardiovascular disease: a nationwide six-year follow-up. BMC Public Health 16:634

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