Cardiovascular Diseases Clinical Trial
To examine how neighborhood-level factors interact with individual characteristics to predict incidence of cardiovascular disease and all-cause mortality.
BACKGROUND:
There are few comprehensive databases that allow for a longitudinal examination of how
neighborhood-level factors may interact with individual characteristics to predict incident
cases of cardiovascular disease (CVD) and all-cause mortality. This cross-institutional
project joins investigators from Karolinska Institutet in Sweden and Stanford University,
known for their expertise in immigrant health and social inequalities in CVD.
DESIGN NARRATIVE:
The study examines how neighborhood social characteristics (e.g., neighborhood socioeconomic
status (SES), social disintegration, socioeconomic and ethnic segregation, social capital),
physical environments (e.g., geocoded assets including goods and services contributing to
health such as educational and recreational resources; barriers to health including
pollution, industries, waste dumps, criminal activity, alcohol and fast food outlets) and
individual factors (e.g., SES, cardiovascular disease {CVD} risk factors, country of birth
and social networks) may interrelate to predict CVD [morbidity and mortality] and all-cause
mortality. Data will be used from a newly created, comprehensive set of Swedish databases,
MigMed and MigSALLS. MigMed (1990-2002) includes data for the entire Swedish population of 6
million women and men aged 25 and older, of whom 600,000 are first generation immigrants.
Their addresses have been geocoded, yielding 9,677 neighborhoods, which will be reduced to a
smaller number of defined units by cluster analyses. MigMed includes an annual assessment of
individual-level sociodemographic and health indicators. Data will also be analyzed from
MigSALLS (1988-2002), which includes more in-depth data from face-to-face interviews with a
representative sample of approximately 18,000 women and men aged 25-74, of whom 2,000 are
first generation immigrants. MigSALLS contains similar individual- and neighborhood-level
factors as MigMed, as well as extensive information on factors that may mediate
relationships between neighborhoods and CVD outcomes (e.g., CVD risk factors such as
smoking, weight, physical activity, and blood pressure). Information from these two datasets
will be matched to hospital and death records (300,000 deaths and 140,000 incidence cases of
CVD expected between 1988-2002), thus creating one of the largest databases in the world
involving men and women from diverse SES levels and countries of origin.
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