Abstract
BackgroundThe intention was to find out whether there was an association between the socio-economic resources in a small neighbourhood ("basic statistical unit"; BSU) and individual mortality, net of individual resources, and whether this association differed between municipalities including a quite large city and others. The possibility of a rural-urban difference in the health effect of community resources has not been checked earlier.MethodsDiscrete-time hazard models for mortality at age 60-89 were estimated for 1990-1992 and 2000-2002, using register data that cover the entire Norwegian population. For each person, the educational level and the municipality and BSU of residence in 1990 and 2000 were known. Average education was computed by aggregating over the individual data. In total, there were about 200000 deaths in more than 13000 BSUs during 5 million person-years of observation.ResultsThere was a significant relationship between average education in the BSU and individual mortality, but only in the medium-sized and largest municipalities. The sharpest relationship was seen in the latter, where for example OR per year of education was 0.908 (95% CI 0.887-0.929) in the 1990-92 period. The findings were robust to various alternative specifications.ConclusionThese results from a large data set are consistent with the idea that neighbourhood socio-economic resources may affect individual mortality, but suggest that distinctions according to population size or density be made in future research and that one should be careful, if focusing on cities, to generalize beyond that setting. With these data, one can only speculate about the reasons for the rural-urban difference. A stronger higher-level spatial segregation in urban areas may be one explanation.
Highlights
The intention was to find out whether there was an association between the socioeconomic resources in a small neighbourhood ("basic statistical unit"; basic statistical units (BSUs)) and individual mortality, net of individual resources, and whether this association differed between municipalities including a quite large city and others
There is little knowledge about the pathways linking individual mortality and community resources [12], but it seems at least reasonable to assume that they involve effects of social interaction with other persons as well as
There may be common factors behind individual mortality and community resources
Summary
The intention was to find out whether there was an association between the socioeconomic resources in a small neighbourhood ("basic statistical unit"; BSU) and individual mortality, net of individual resources, and whether this association differed between municipalities including a quite large city and others. Many recent multilevel studies from a variety of countries [2,3], including the Nordic ones [4,5,6,7], have suggested that, among persons who themselves have the same level of resources, those who live in a community that is relatively advantaged socio-economically have lower mortality and better health than others. Such effects have not shown up in all investigations, though [8,9,10,11]. Some results suggest that the community effects are sharpest at a relatively low level [27], but the empirical picture is far from clear
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