Neighborhood characteristics and incident myocardial infarction in US older adults: evaluation in 2 nationwide cohorts

Abstract Inconsistent findings on the associations of adverse neighborhood context with myocardial infarction (MI) or racial disparities in MI may reflect publication bias or chance. We compared results from harmonized analyses of the REasons for Geographic and Racial Differences in Stroke (REGARDS, n = 25 196, aged ≥45 years, 42% Black; 2003-2018) study and the Health and Retirement Study (HRS, n = 14 191, aged >50 years, 13% Black; 2004-2018). For both cohorts, we used 51 American Community Survey (ACS) census tract variables to predict hazard of incident MI using Cox models. We evaluated consistency of coefficients and Black-White differences in coefficients between cohorts. Cumulative MI incidence in REGARDS (6.2% over 11.5 years median follow-up) was similar to HRS (7.1% over 13.1 years median follow-up). Of 51 ACS predictors evaluated, the log(HR) for incident MI differed by ≤0.05 between REGARDS and HRS for 34 variables. Of the 12 census tract predictors with significantly different associations with MI for Black versus White respondents in REGARDS, none showed interactions with race in HRS at the P <.05 threshold. Neighborhood socioeconomic associations with MI across 2 national studies were largely replicable. Racial differences in associations were inconsistent.