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 F. Abraido-Lanza, Marian R. Passannante

Research output: Contribution to journalArticlepeer-review


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
Issue number4
StatePublished - Apr 1 2016


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

ASJC Scopus subject areas

  • Epidemiology


Dive into the research topics of 'The joint contribution of neighborhood poverty and social integration to mortality risk in the United States'. Together they form a unique fingerprint.

Cite this