Associations between Area-Level Unemployment, Body Mass Index, and Risk Factors for Cardiovascular Disease in an Urban Area

Abstract

Introduction: Cardiovascular Disease (CVD) has been linked to "neighbourhood" socioeconomic status (nSES), often operationalized as a composite index of aggregate income, occupation and education within predefined administrative boundaries. The role of specific, non-composite socioeconomic markers has not been clearly explained. It is also unclear whether the relationship between nSES and CVD varies according to sex. We sought to determine whether area-level unemployment (ALU) was associated with CVD risk, and whether this association differed by sex. Methods: 342 individuals from the Montreal Neighbourhood Survey of Lifestyle and Health provided self-reported behavioural and socioeconomic information. A nurse collected biochemical and anthropometric data. ALU, a weighted average of the proportion of persons 15-years and older available for but without work, was measured using a Geographic Information System for a 250 m buffer centred on individual residence. Generalized Estimating Equations were used to estimate the associations between ALU, body mass index (BMI) and a cumulative score for total cardiometabolic risk (TCR). Results: After confounder adjustments, the mean 4th minus 1st quartile difference in BMI was 3.19 kg/m2 (95% CI: 2.39, 3.99), while the prevalence ratio for the 4th relative to 1st quartile for TCR was 2.20 (95 % CI: 1.53, 3.17). Sex interacted with ALU; women relative to men had greater mean 3.97 kg/m2 (95% CI: 2.08, 5.85) BMI and greater mean TCR 1.51 (95% CI: 0.78, 2.90), contrasted at mean ALU. Conclusions: Area-level unemployment is associated with greater CVD risk, and this association is stronger for women