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A Small-area Ecologic Study of Myocardial Infarction, Neighborhood Deprivation, and Sex: A Bayesian Modeling Approach

Deguen, Séverinea; Lalloue, Benoîta; Bard, Denisa; Havard, Sabrinaa,b; Arveiler, Dominiquec; Zmirou-Navier, Denisa,d,e

doi: 10.1097/EDE.0b013e3181e09925
Psychosocial: Original Article

Background: Socioeconomic inequalities in the risk of coronary heart disease (CHD) are well documented for men and women. CHD incidence is greater for men but its association with socioeconomic status is usually found to be stronger among women. We explored the sex-specific association between neighborhood deprivation level and the risk of myocardial infarction (MI) at a small-area scale.

Methods: We studied 1193 myocardial infarction events in people aged 35–74 years in the Strasbourg metropolitan area, France (2000–2003). We used a deprivation index to assess the neighborhood deprivation level. To take into account spatial dependence and the variability of MI rates due to the small number of events, we used a hierarchical Bayesian modeling approach. We fitted hierarchical Bayesian models to estimate sex-specific relative and absolute MI risks across deprivation categories. We tested departure from additive joint effects of deprivation and sex.

Results: The risk of MI increased with the deprivation level for both sexes, but was higher for men for all deprivation classes. Relative rates increased along the deprivation scale more steadily for women and followed a different pattern: linear for men and nonlinear for women. Our data provide evidence of effect modification, with departure from an additive joint effect of deprivation and sex.

Conclusions: We document sex differences in the socioeconomic gradient of MI risk in Strasbourg. Women appear more susceptible at levels of extreme deprivation; this result is not a chance finding, given the large difference in event rates between men and women.

From the aDepartment of Environmental and Occupational Health, EHESP School of Public Health, Rennes, France; bINSERM U707, Paris, France; cDepartment of Epidemiology and Public Health, Strasbourg University, Medical School, Strasbourg, France; dINSERM U954, Vandœuvre-les-Nancy, France; and eNancy University, Medical School, Vandœuvre-les-Nancy, France.

Submitted 19 May 2009; accepted 4 January 2010; posted 20 May 2010.

Supported by the National Research Agency (grant ANR 06SEST27) and the National Agency for Environmental and Occupational Health Safety (grant AFSSET EST-2006/1/2).

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Correspondence: Séverine Deguen, Department of Environmental and Occupational Health, EHESP School of Public Health, Avenue du Professeur Léon Bernard, 35043 Rennes Cedex, France. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.