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

Ann Epidemiol. 2016 Apr;26(4):261-6. doi: 10.1016/j.annepidem.2016.02.006. Epub 2016 Mar 3.

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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Interpersonal Relations
  • Male
  • Middle Aged
  • Mortality*
  • Nutrition Surveys
  • Population Surveillance
  • Poverty Areas
  • Poverty*
  • Residence Characteristics*
  • Social Determinants of Health*
  • Social Participation*
  • Social Support
  • Socioeconomic Factors
  • United States / epidemiology
  • Young Adult