Exposure to New York City as a risk factor for heart attack mortality.

OBJECTIVE If New York City (NYC) residents' unusually high rate of ischemic heart disease (IHD) results from chronic exposure to that city, there might also be an effect of acute exposure among visitors to NYC. We explored this possibility and also whether IHD is reduced among NYC residents dying away from the city. METHODS Using all US death certificates for 1985-1994, we examined (correcting for age, race, and sex) IHD deaths in three groups: NYC residents who died in the city, non-NYC residents visiting the city, and NYC residents traveling out of the city. RESULTS IHD deaths among NYC residents dying in the city were 155% of the expected proportion (p < .0001). Among visitors to the city, such deaths were 134% of the expected proportion (p < .0001). The proportion of IHD deaths among NYC residents dying out of the city was only 80% of the expected value (p <.0001). These effects are not due to nearby commuters, recent immigrants, local classification practices, or socioeconomic status, and they do not appear in other US cities. CONCLUSIONS With both chronic and acute effects of exposure to NYC, these data are consistent with the hypothesis that the stress of NYC is linked to the high rate of IHD.