The joint contribution of neighborhood poverty and social integration to mortality risk in the United States

Andrea Fleisch Marcus, Sandra E. Echeverria, Bart K. Holland, Ana Abraido-Lanza, Marian R. Passannante

Research output: Contribution to journalArticle

Abstract

Purpose: A well-established literature has shown that social integration strongly patterns health, including mortality risk. However, the extent to which living in high-poverty neighborhoods and having few social ties jointly pattern survival in the United States has not been examined. Methods: We analyzed data from the Third National Health and Nutrition Examination Survey (1988-1994) linked to mortality follow-up through 2006 and census-based neighborhood poverty. We fit Cox proportional hazards models to estimate associations between social integration and neighborhood poverty on all-cause mortality as independent predictors and in joint-effects models using the relative excess risk due to interaction to test for interaction on an additive scale. Results: In the joint-effects model adjusting for age, gender, race/ ethnicity, and individual-level socioeconomic status, exposure to low social integration alone was associated with increased mortality risk (hazard ratio [HR]: 1.42, 95% confidence interval [CI]: 1.28-1.59) while living in an area of high poverty alone did not have a significant effect (HR: 1.10; 95% CI: 0.95-1.28) when compared with being jointly unexposed. Individuals simultaneously living in neighborhoods characterized by high poverty and having low levels of social integration had an increased risk of mortality (HR: 1.63; 95% CI: 1.35-1.96). However, relative excess risk due to interaction results were not statistically significant. Conclusions: Social integration remains an important determinant of mortality risk in the United States independent of neighborhood poverty.

Original languageEnglish (US)
Pages (from-to)261-266
Number of pages6
JournalAnnals of Epidemiology
Volume26
Issue number4
DOIs
StatePublished - Apr 1 2016

Fingerprint

Poverty
Mortality
Confidence Intervals
Joints
Poverty Areas
Nutrition Surveys
Censuses
Proportional Hazards Models
Social Class
Odds Ratio
Health

Keywords

  • Mortality
  • Neighborhood
  • Social determinants of health
  • Social support

ASJC Scopus subject areas

  • Epidemiology

Cite this

The joint contribution of neighborhood poverty and social integration to mortality risk in the United States. / Marcus, Andrea Fleisch; Echeverria, Sandra E.; Holland, Bart K.; Abraido-Lanza, Ana; Passannante, Marian R.

In: Annals of Epidemiology, Vol. 26, No. 4, 01.04.2016, p. 261-266.

Research output: Contribution to journalArticle

Marcus, Andrea Fleisch ; Echeverria, Sandra E. ; Holland, Bart K. ; Abraido-Lanza, Ana ; Passannante, Marian R. / The joint contribution of neighborhood poverty and social integration to mortality risk in the United States. In: Annals of Epidemiology. 2016 ; Vol. 26, No. 4. pp. 261-266.
@article{c8d8ff458ec940cd9c98fbf00b1286c9,
title = "The joint contribution of neighborhood poverty and social integration to mortality risk in the United States",
abstract = "Purpose: A well-established literature has shown that social integration strongly patterns health, including mortality risk. However, the extent to which living in high-poverty neighborhoods and having few social ties jointly pattern survival in the United States has not been examined. Methods: We analyzed data from the Third National Health and Nutrition Examination Survey (1988-1994) linked to mortality follow-up through 2006 and census-based neighborhood poverty. We fit Cox proportional hazards models to estimate associations between social integration and neighborhood poverty on all-cause mortality as independent predictors and in joint-effects models using the relative excess risk due to interaction to test for interaction on an additive scale. Results: In the joint-effects model adjusting for age, gender, race/ ethnicity, and individual-level socioeconomic status, exposure to low social integration alone was associated with increased mortality risk (hazard ratio [HR]: 1.42, 95{\%} confidence interval [CI]: 1.28-1.59) while living in an area of high poverty alone did not have a significant effect (HR: 1.10; 95{\%} CI: 0.95-1.28) when compared with being jointly unexposed. Individuals simultaneously living in neighborhoods characterized by high poverty and having low levels of social integration had an increased risk of mortality (HR: 1.63; 95{\%} CI: 1.35-1.96). However, relative excess risk due to interaction results were not statistically significant. Conclusions: Social integration remains an important determinant of mortality risk in the United States independent of neighborhood poverty.",
keywords = "Mortality, Neighborhood, Social determinants of health, Social support",
author = "Marcus, {Andrea Fleisch} and Echeverria, {Sandra E.} and Holland, {Bart K.} and Ana Abraido-Lanza and Passannante, {Marian R.}",
year = "2016",
month = "4",
day = "1",
doi = "10.1016/j.annepidem.2016.02.006",
language = "English (US)",
volume = "26",
pages = "261--266",
journal = "Annals of Epidemiology",
issn = "1047-2797",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - The joint contribution of neighborhood poverty and social integration to mortality risk in the United States

AU - Marcus, Andrea Fleisch

AU - Echeverria, Sandra E.

AU - Holland, Bart K.

AU - Abraido-Lanza, Ana

AU - Passannante, Marian R.

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Purpose: A well-established literature has shown that social integration strongly patterns health, including mortality risk. However, the extent to which living in high-poverty neighborhoods and having few social ties jointly pattern survival in the United States has not been examined. Methods: We analyzed data from the Third National Health and Nutrition Examination Survey (1988-1994) linked to mortality follow-up through 2006 and census-based neighborhood poverty. We fit Cox proportional hazards models to estimate associations between social integration and neighborhood poverty on all-cause mortality as independent predictors and in joint-effects models using the relative excess risk due to interaction to test for interaction on an additive scale. Results: In the joint-effects model adjusting for age, gender, race/ ethnicity, and individual-level socioeconomic status, exposure to low social integration alone was associated with increased mortality risk (hazard ratio [HR]: 1.42, 95% confidence interval [CI]: 1.28-1.59) while living in an area of high poverty alone did not have a significant effect (HR: 1.10; 95% CI: 0.95-1.28) when compared with being jointly unexposed. Individuals simultaneously living in neighborhoods characterized by high poverty and having low levels of social integration had an increased risk of mortality (HR: 1.63; 95% CI: 1.35-1.96). However, relative excess risk due to interaction results were not statistically significant. Conclusions: Social integration remains an important determinant of mortality risk in the United States independent of neighborhood poverty.

AB - Purpose: A well-established literature has shown that social integration strongly patterns health, including mortality risk. However, the extent to which living in high-poverty neighborhoods and having few social ties jointly pattern survival in the United States has not been examined. Methods: We analyzed data from the Third National Health and Nutrition Examination Survey (1988-1994) linked to mortality follow-up through 2006 and census-based neighborhood poverty. We fit Cox proportional hazards models to estimate associations between social integration and neighborhood poverty on all-cause mortality as independent predictors and in joint-effects models using the relative excess risk due to interaction to test for interaction on an additive scale. Results: In the joint-effects model adjusting for age, gender, race/ ethnicity, and individual-level socioeconomic status, exposure to low social integration alone was associated with increased mortality risk (hazard ratio [HR]: 1.42, 95% confidence interval [CI]: 1.28-1.59) while living in an area of high poverty alone did not have a significant effect (HR: 1.10; 95% CI: 0.95-1.28) when compared with being jointly unexposed. Individuals simultaneously living in neighborhoods characterized by high poverty and having low levels of social integration had an increased risk of mortality (HR: 1.63; 95% CI: 1.35-1.96). However, relative excess risk due to interaction results were not statistically significant. Conclusions: Social integration remains an important determinant of mortality risk in the United States independent of neighborhood poverty.

KW - Mortality

KW - Neighborhood

KW - Social determinants of health

KW - Social support

UR - http://www.scopus.com/inward/record.url?scp=84962548477&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84962548477&partnerID=8YFLogxK

U2 - 10.1016/j.annepidem.2016.02.006

DO - 10.1016/j.annepidem.2016.02.006

M3 - Article

VL - 26

SP - 261

EP - 266

JO - Annals of Epidemiology

JF - Annals of Epidemiology

SN - 1047-2797

IS - 4

ER -