原创力文档a prospective cohort study of neighborhood stress and ischemic heart disease in japan a multilevel analysis using the jacc study data前瞻性群组研究社区压力和缺血性心脏病在日本使用jacc的多层次分析研究数据.pdfVIP
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a prospective cohort study of neighborhood stress and ischemic heart disease in japan a multilevel analysis using the jacc study data前瞻性群组研究社区压力和缺血性心脏病在日本使用jacc的多层次分析研究数据
Fujino et al. BMC Public Health 2011, 11:398
/1471-2458/11/398
RESEARCH ARTICLE Open Access
A prospective cohort study of neighborhood
stress and ischemic heart disease in Japan:
a multilevel analysis using the JACC study data
1* 2 3 4 5 6 7
Yoshihisa Fujino , Naohito Tanabe , Kaori Honjo , Sadao Suzuki , Kokoro Shirai , Hiroyasu Iso , Akiko Tamakoshi
and for JACC Study Group
Abstract
Background: A body of research has shown that neighborhood environment may have an effect on a variety of
health outcomes, including cardiovascular disease. One explanation for the mechanism of the effect of
neighborhood on cardiovascular disease is psychosocial pathways. Direct evidence for an effect of neighborhood
on cardiovascular disease with adjustment for perceived stress at the individual level has not been obtained,
however. The Japan Collaborative Cohort Study for the Evaluation of Cancer Risk provides a unique dataset which
has aggregated area-based cohorts from 45 areas throughout Japan. The purpose of the present study was to
examine the contextual effect of area-level stress on ischemic heart disease using data from a large prospective
cohort in Japan.
Methods: A baseline survey of 110,792 residents of 45 areas aged 40-79 years was conducted between 1988 and
1990. Analysis was restricted to subjects from the 33 of 45 areas providing information about self-rated stress
(32183 men and 45896 women). Multilevel Poisson regression models were employed in a two-level structure of
individuals nested within the 33 areas. Area-level stress was calculated by sex as the number of persons who rated
their stress level as high divided by the total number of subjects in that area. Mortality rate ratios (MRRs) p
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