Even after controlling for personal income, education, and occupation, we found that living in a disadvantaged neighborhood is associated with an increased incidence of coronary heart disease.

Multilevel models were used to account for the multilevel structure of the data. Living in lower income neighbourhoods was generally associated with decreased energy adjusted intake of fruits, vegetables, fish, and increased intake of meat. Patterns generally persisted after adjustment for individual level income, but were often not statistically significant. Inconsistent associations were recorded for the intake of saturated fat, polyunsaturated fat, and cholesterol. Overall, individual level income was a more consistent predictor of diet than neighbourhood income. Conclusion-Despite limitations in the definition and characterisation of neighbourhoods, this study found consistent (albeit small) diVerences across neighbourhoods in food intake, suggesting that more in depth research into potential neighbourhood level determinants of diet is warranted. (J Epidemiol Community Health 1999;53:55-63) Over the past three decades, numerous studies conducted in industrialised nations have documented higher coronary heart disease incidence, prevalence, and mortality in the lower than in the higher social classes.

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