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 F.
AU - Passannante, Marian R.
N1 - Funding Information:
Support for preparing this article was provided, in part, by the National Institutes of Health (grants R25GM062454 and UL1TR000040 ). Part of this work was supported by Diversity Supplement R01CA49705-0281 and the Robert Wood Johnson Foundation , Active Living Research , New Connections Program.
Publisher Copyright:
© 2016 Elsevier Inc.
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
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U2 - 10.1016/j.annepidem.2016.02.006
DO - 10.1016/j.annepidem.2016.02.006
M3 - Article
C2 - 27016951
AN - SCOPUS:84962548477
SN - 1047-2797
VL - 26
SP - 261
EP - 266
JO - Annals of Epidemiology
JF - Annals of Epidemiology
IS - 4
ER -