A Longitudinal Analysis of the Relationships between
Neighborhood SES, Neighborhood Residential Stability,
and Mortality among Women in the U.S.
Chloe E. Bird
Eibner C, Shih RA, Griffin BA, Slaughter ME, Dubowitz T,
Escarce JJ, Margolis K, Mouton C, Whitsel E
AcademyHealth
June 26, 2010
Does Neighborhood SES Influence
Mortality Risk in Women?
• A substantial literature links neighborhood SES
(NSES) characteristics to individual’s health, even
adjusting for their income or education
• Our prior work has linked NSES to risk of coronary
heart disease (CHD) and CHD mortality, adjusting
for SES, medical history and health behavior
• Here, we use national longitudinal data to examine
whether NSES and residential stability are
associated with mortality risk in women
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How Might Neighborhood Socioeconomic
Status (NSES) Affect Mortality Risk?
•
Increased exposure to stressors such as
violence and poverty
•
Reduced availability to outlets for nutritious food
and physical activity
•
Reduced access to quality health care services
•
Increased exposure to environmental pollutants
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How Might Residential Stability Affect
Mortality Risk?
• Neighborhoods with lower residential stability may
have less trust and weaker social ties
• Less stable neighborhoods may yield more
negative interactions and less support among
residents
• Residential stability may explain or confound the
relationship between NSES and mortality.
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Data
•
•
Geo-coded WHI Clinical Trial

N=50,498 women, age 50-79

Followed for up to 12 years

Data from 76 U.S. sites
Census data

NSES data at the census-tract level

Residential stability at the census-tract level
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Components of NSES Index
•
Median household income
•
Adults ≤ high school education (%)
•
Male unemployment (%)
•
Households with income below poverty (%)
•
Households receiving public assistance (%)
•
Households headed by a single female (%)
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Residential Stability
Measure of the percentage of census-tract
residents who were living in the same home 5 years
earlier.
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Outcome
All-cause mortality
4.67%
(n = 2365)
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Methods
• Cox Proportional Hazard models
• Adjusted for baseline individual-level
 Socio-demographic characteristics
 Related comorbid conditions
 Health behaviors
 Family history of MI
• Accounted for geographic clustering
• Assessed 3 potential mediators of neighborhood effects
 Abuse in the past year
 Depression
 Living alone
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Baseline Characteristics
• Race/ethnicity



81% non-Hispanic white
9 % non-Hispanic black
4% Hispanic
• 61% Married
• 94% ≥ High school
• Household income
 40%
≤ $34,999


$35,000 - $74,999
≥$75,000
41%
17%
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Lower NSES and Lower Residential Stability
are Independently Associated with
Increased Hazard of Mortality
1.5
1.4
Hazard Ratios
1.3
1.2
1.1
1
0.9
0.8
0.7
0.6
0.5
NSES
Residential Stability
Abuse
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Results In a Real World Context
Northwest DC
Southeast
DC
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Mortality Hazard Ratios:
Northwest vs. Southeast DC
1.10
Hazard Ratios
1.00
0.94
0.90
0.80
0.79
0.70
0.60
0.50
NSES
Residential Stability
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Limitations
• Limited generalizability of the WHI sample
• Longitudinal analysis not sufficient to infer
causality
• Healthier individuals may choose to live in
better neighborhoods
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Conclusions
• Living in a higher NSES neighborhood or with
greater residential stability is associated with lower
mortality risk among older women
• The protective effect of living in a neighborhood with
higher residential stability suggests that social aspects
of communities are salutary
• The effects of NSES and residential stability were not
modified by race/ethnicity, income or education
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Implications
• Future research should examine mechanisms thorough
which neighborhood characteristics influence health
and risk of death
• Social policies targeting neighborhood characteristics
may improve both individual and population health
• Medical and public health efforts should include more
aggressive screening of women living in low NSES
neighborhoods
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Collaborators
Chloe Bird, PI
Karen Margolis
Christine Eibner, co-PI Charles Mouton
Regina Shih
Tamara Dubowitz
Jose Escarce
Mary Ellen Slaughter
Beth Ann Griffin
Eric Whitsel
Study funded by NHLBI R01HL084425
The authors declare no conflict of interest
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