Health-promoting and health-damaging neighbourhood resources and coronary heart disease: a follow-up study of 2 165 000 people

Background It has been hypothesised that the presence of health-damaging factors and lack of health-promoting factors lie in the causal pathway between neighbourhood deprivation and coronary heart disease (CHD). This study is the first to examine the associations between individual-level CHD risk and neighbourhood availability of fast-food restaurants, bars/pubs, physical activity facilities and healthcare resources. Methods Multilevel logistic regression models were used for the follow-up of 1 065 000 men and 1 100 000 women (aged 35-80 years) between 1 December 2005 and 31 December 2007, for individual-level CHD events (both morbidity and mortality). Results The relatively weak associations between neighbourhood availability of potentially health-damaging and health-promoting goods, services and resources, and CHD incidence no longer remained significant after adjustment for neighbourhood-level deprivation and individual-level age and income. Conclusions The presence of potentially health-damaging factors and lack of potentially health-promoting factors do not seem to contribute significantly to the development of CHD. Other features of deprived neighbourhoods appear to play a greater role.