Abstract
There is an overreliance on concurrent neighbourhood deprivation as a determinant of health. Only a small section of the literature focuses on the cumulative exposure of neighbourhood deprivation over the life course. This paper uses data from the 1958 National Child Development Study, a British birth cohort study, linked to 1971–2011 Census data at the neighbourhood level to longitudinally model self-rated health between ages 23 and 55 by Townsend deprivation score between ages 16 and 55. Change in self-rated health is analysed using ordinal multilevel models to test the strength of association with neighbourhood deprivation at age 16, concurrently and cumulatively. The results show that greater neighbourhood deprivation at age 16 predicts worsening self-rated health between ages 33 and 50. The association with concurrent neighbourhood deprivation is shown to be stronger compared with the measurement at age 16 when both are adjusted in the model. The concurrent association with change in self-rated health is explained by cumulative neighbourhood deprivation. These findings suggest that neglecting exposure to neighbourhood deprivation over the life course will underestimate the neighbourhood effect. They also have potential implications for public policy suggesting that neighbourhood socioeconomic equality may bring about better population health.
Highlights
Published: 30 September 2021This paper aims to overcome a common limitation in neighbourhood effects research which is a reliance on concurrent neighbourhood of residence to determine whether there is anything about the places individuals live in which impacts on their health [1]
We aim to overcome the reliance on concurrent neighbourhood deprivation to test neighbourhood effects using a family of longitudinal models and ask three research questions under the assumptions of these models: (1) is neighbourhood deprivation at age 16 related to self-rated health up to age 55; (2) if there is, is the relationship between neighbourhood deprivation at age 16 and change in self-rated health up to age 55 explained by neighbourhood deprivation at intermediate ages; and (3) are changes in self-rated health up to age 55 explained by variation in cumulative values of neighbourhood deprivation up to that age, or concurrent values at that age? We use Census data, 1971–2011, linked to a
Individual data are taken from the 1958 National Child Development Study (NCDS), which is an interdisciplinary study of births in England, Scotland and Wales in a single week of 1958 who have been followed up at various time points ever since [14]
Summary
This paper aims to overcome a common limitation in neighbourhood effects research which is a reliance on concurrent neighbourhood of residence to determine whether there is anything about the places individuals live in which impacts on their health [1]. There is a growing evidence-base suggesting it is not where you live today, rather your cumulative neighbourhood history; considering duration of exposure to a neighbourhood and the impact of both in situ neighbourhood change and migration between neighbourhoods. It is important to take account of neighbourhood histories because people may remain connected to neighbourhoods they have previously lived in by way of at least two of the processes identified by Galster [2] in a seminal paper on how neighbourhood can causally affect individual outcomes: through (1) continued social ties with family and friends and (2) institutional ties with schools and other services in a previous neighbourhood [3]. We focus on neighbourhood socioeconomic deprivation often measured through a composite of indicators (e.g., unemployment, overcrowding, household tenure and education) or a single item (e.g., income or unemployment) and provide a summary of the evidence on how exposure to more deprived neighbourhoods over time impacts on health.
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