No Man is an Island: The Impact of Neighborhood Disadvantage on Mortality.

Darrell Gaskin,Christine Buttorff,Kitty Chan,Benjo Delarmente,Rachael Mccleary,Eric Roberts

doi:10.3390/ijerph16071265

Abstract

This study’s purpose is to determine if neighborhood disadvantage, air quality, economic distress, and violent crime are associated with mortality among term life insurance policyholders, after adjusting for individual demographics, health, and socioeconomic characteristics. We used a sample of approximately 38,000 term life policyholders, from a large national life insurance company, who purchased a policy from 2002 to 2010. We linked this data to area-level data on neighborhood disadvantage, economic distress, violent crime, and air pollution. The hazard of dying for policyholders increased by 9.8% (CI: 6.0–13.7%) as neighborhood disadvantage increased by one standard deviation. Area-level poverty and mortgage delinquency were important predictors of mortality, even after controlling for individual personal income and occupational status. County level pollution and violent crime rates were positively, but not statistically significantly, associated with the hazard of dying. Our study provides evidence that neighborhood disadvantage and economic stress impact individual mortality independently from individual socioeconomic characteristics. Future studies should investigate pathways by which these area-level factors influence mortality. Public policies that reduce poverty rates and address economic distress can benefit everyone’s health.

Highlights

Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health; MedStar-Georgetown Surgical Outcomes Research Center, MedStar Health Research Institute and Medstar
A study of 107 U.S cities showed that the prevalence of vacant or boarded up houses is associated with a higher risk of premature mortality due to diabetes, homicide, and suicide [12]
We examined whether the impact of neighborhood disadvantage on the hazard of dying varied for persons who moved compared to persons who lived in the same zip code for the observation period (See Table 7)

Summary

Introduction

This study’s purpose is to determine if neighborhood disadvantage, air quality, economic distress, and violent crime are associated with mortality among term life insurance policyholders, after adjusting for individual demographics, health, and socioeconomic characteristics. We used a sample of approximately 38,000 term life policyholders, from a large national life insurance company, who purchased a policy from 2002 to 2010 We linked this data to area-level data on neighborhood disadvantage, economic distress, violent crime, and air pollution. Where someone lives determines their exposure to characteristics of the physical environment that impact health, such as pollution, housing, infrastructure, and the built environment These environmental factors include air and water quality, exposure to hazardous materials, such as lead, asbestos, and industrial waste, and general safety. Violent crime is associated with higher county-level mortality, while the percentages of married households and Hispanic and Asian residents are predictive factors [11]

Methods

Results

Discussion

Conclusion