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

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

Author information

1
Department of Nutritional Sciences, Rutgers, School of Health Related Professions, Newark, NJ. Electronic address: marcusab@shrp.rutgers.edu.
2
Department of Community Health and Social Sciences, City University of New York Graduate School of Public Health and Health Policy, New York, NY.
3
Rutgers New Jersey Medical School, Newark, NJ.
4
Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY.
5
Department of Epidemiology, Rutgers School of Public Health, Newark, NJ.

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

PMID:
27016951
DOI:
10.1016/j.annepidem.2016.02.006
[Indexed for MEDLINE]

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