The health potential of neighborhoods: A population-wide study in the Netherlands

L.H Dekker,L.H Dekker,R.H Rijnks,J.O Mierau,J.O Mierau

doi:10.1016/j.ssmph.2021.100867

Abstract

BackgroundWhile differences in population health across neighborhoods with different socioeconomic characteristics are well documented, health disparities across neighborhoods with similar socioeconomic characteristics are less well understood. We aimed to estimate population health inequalities, both within and between neighborhoods with similar socioeconomic status, and assessed the association of neighborhood characteristics and socioeconomic spillover effects from adjacent neighborhoods. MethodsBased on Dutch whole-population data we determined the percentage of inhabitants with good or very good self-assessed health (SAH) and the percentage of inhabitants with at least one chronic disease (CD) in 11,504 neighborhoods. Neighborhoods were classified by quintiles of a composite neighborhoods socioeconomic status score (NSES). A set of spatial models was estimated accounting for spatial effects in the dependent, independent, and error components of the model. ResultsSubstantial population health disparities in SAH and CD both within and between neighborhoods NSES quintiles were observed, with the largest SAH variance in the lowest NSES group. Neighborhoods adjacent to higher SES neighborhoods showed a higher SAH and a lower prevalence of CD. Projected impacts from the spatial regressions indicate how modest changes in NSES among the lowest socioeconomic neighborhoods can contribute to population health in both low- and high-SES neighborhoods. ConclusionPopulation health differs substantially among neighborhoods with similar socioeconomic characteristics, which can partially be explained by a spatial socio-economic spillover effect.

Highlights

While differences in population health across neighborhoods with different socioeconomic charac teristics are well documented, health disparities across neighborhoods with similar socioeconomic characteristics are less well understood
Focusing on the Netherlands, de Boer et al (2020) find that, overall, lower neighborhoods socioeconomic status score (NSES) is associated with worse health behavior but that this is notably different for excessive alcohol use, which is prevalent among high-income neighborhoods
We find substantial population health disparities in self-assessed health (SAH) and chronic disease (CD) both between neighborhoods with different and neighborhoods with similar socioeconomic characteristics (Supplementary Table S3)

Summary

Introduction

While differences in population health across neighborhoods with different socioeconomic charac teristics are well documented, health disparities across neighborhoods with similar socioeconomic characteristics are less well understood. We aimed to estimate population health inequalities, both within and between neighborhoods with similar socioeconomic status, and assessed the association of neighborhood characteristics and socioeconomic spillover effects from adjacent neighborhoods. Projected impacts from the spatial regressions indicate how modest changes in NSES among the lowest socioeconomic neighborhoods can contribute to population health in both low- and high-SES neighborhoods. Conclusion: Population health differs substantially among neighborhoods with similar socioeconomic charac teristics, which can partially be explained by a spatial socio-economic spillover effect. Focusing on the Netherlands, de Boer et al (2020) find that, overall, lower NSES is associated with worse health behavior but that this is notably different for excessive alcohol use, which is prevalent among high-income neighborhoods

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