Abstract A46: Neighborhood socioeconomic deprivation and all-cause, cancer-, and CVD-specific mortality: NIH-AARP Study

Abstract

Abstract Background: The impact of person-level socioeconomic status (SES) on mortality is well documented. However, residing in deprived areas may increase the risk of mortality beyond that explained by a person's own SES-related factors and lifestyle. As few studies possess both person-level and area-level data, the interaction between these measures, though potentially of significant importance, is poorly understood. The large longitudinal NIH-AARP Study provides a rich resource to personal characteristics and health risk factors and is linked to census tract data which details the composition and socioeconomic context of each participant's local environment. The purpose of the present study was to examine the relation between neighborhood socioeconomic deprivation and all-cause, cancer-and cardiovascular disease (CVD)-specific mortality for men and women after accounting for education and other important person-level risk factors. Design, Setting, and Participants: In the longitudinal National Institutes of Health (NIH)-AARP (formerly known as the American Association of Retired Persons) Diet and Health Study, we analyzed data from healthy participants, ages 50-71 years at baseline. Deaths (n=33831) were identified through linkage to Social Security Administration Death Master File and National Death Index from recruitment (1995-1996) to December 31,2005. Information on census tracts was obtained from the 2000 US Census. A multilevel analysis approach was employed; marginal and random effects (frailty) models for Cox proportional hazards regression, which account for correlation of individuals residing within the same census track, estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for quintiles of neighborhood deprivation. Multivariable models were adjusted for person-level risk factors, including age, education, smoking, physical activity, body mass index, and diet. Results: During a median follow-up of 9.5 years, 21843 men and 11988 women died. Participants residing in the highest vs. lowest quintile of the deprivation index had elevated risks for overall mortality (HRmen=1.17,95% CI=1.10-1.24; HRwomen=1.13,95% CI=1.05-1.22) and marginally increased risk for cancer mortality (HRmen=1.09,95% CI=1.00-1.20; HRwomen=1.09,95% CI=0.99-1.22). Regarding CVD mortality, associations appeared stronger in men (HR=1.33,95% CI=1.19-1.49) than women (HR=1.18,95% CI=1.01-1.38). There was no evidence of an effect modification by education. Conclusion: Higher neighborhood socioeconomic deprivation was associated with modest increases in all-cause mortality, cancer mortality, and cardiovascular disease mortality in both men and women even after accounting for a large number of established risk factors. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A46.