Association of Neighborhood Conditions and Resources for Children With Life Expectancy at Birth in the US

Abstract

ImportanceTo address inequities in life expectancy, we must understand the associations of modifiable socioeconomic and structural factors with life expectancy. However, the association of limited neighborhood resources and deleterious physical conditions with life expectancy is not well understood.ObjectiveTo evaluate the association of community social and economic conditions and resources for children with life expectancy at birth.Design, Setting, and ParticipantsThis cross-sectional study examined neighborhood child opportunity and life expectancy using data from residents of 65 662 US Census tracts in 2015. The analysis was conducted from July 6 to October 1, 2021.ExposuresNeighborhood conditions and resources for children in 2015.Main Outcomes and MeasuresThe primary outcome was life expectancy at birth at the Census tract level based on data from the US Small-Area Life Expectancy Estimates Project (January 1, 2010, to December 31, 2015). Neighborhood conditions and resources for children were quantified by Census tract Child Opportunity Index (COI) 2.0 scores for 2015. This index captures community conditions associated with children’s health and long-term outcomes categorized into 5 levels, from very low to very high opportunity. It includes 29 indicators in 3 domains: education, health and environment, and social and economic factors. Mixed-effects and simple linear regression models were used to estimate the associations between standardized COI scores (composite and domain-specific) and life expectancy.ResultsThe study included residents from 65 662 of 73 057 US Census tracts (89.9%). Life expectancy at birth across Census tracts ranged from 56.3 years to 93.6 years (mean [SD], 78.2 [4.0] years). Life expectancy in Census tracts with very low COI scores was lower than life expectancy in Census tracts with very high COI scores (−7.06 years [95% CI, −7.13 to −6.99 years]). Stepwise associations were observed between COI scores and life expectancy. For each domain, life expectancy was shortest in Census tracts with very low compared with very high COI scores (education: β = −2.02 years [95% CI, −2.12 to −1.92 years]); health and environment: β = −2.30 years [95% CI, −2.41 to −2.20 years]; social and economic: β = −4.16 years [95% CI, −4.26 to −4.06 years]). The models accounted for 41% to 54% of variability in life expectancy at birth (R2 = 0.41-0.54).Conclusions and RelevanceIn this study, neighborhood conditions and resources for children were significantly associated with life expectancy at birth, accounting for substantial variability in life expectancy at the Census tract level. These findings suggest that community resources and conditions are important targets for antipoverty interventions and policies to improve life expectancy and address health inequities.

Neighborhood Opportunity and Life Expectancy at Birth

“…The results of the study by Shanahan et al provide important insights into children’s life expectancy in the US, yet the findings should be interpreted within the context of several limitations, many of which the authors point out. First, the US Small-Area Life Expectancy Estimates Project lacks information on race and ethnicity; therefore, these factors were not able to be examined.…”

“…The results of the study by Shanahan et al 1 provide important insights into children's life expectancy in the US, yet the findings should be interpreted within the context of several limitations,…”

“…Although there is an extensive body of literature concentrating on the association between sociodemographic factors and measures of survival, such as infant mortality and life expectancy, most studies to date, including 1 recent study by Boeing et al, have examined the association of individual factors, including area of residence (eg, zip code), race, and income, and have found a differential association with life expectancy. Shanahan et al expanded on the current literature by using the COI 2.0, which provides a more comprehensive evaluation of the interplay between sociodemographic factors and children’s life expectancy. Earlier investigation has been limited to studying larger geographic boundaries, including state and county lines, whereas the COI 2.0 uses the smaller measure of Census tracts.…”

“…Where children live has substantial implications for their health and longevity. Elsewhere in JAMA Network Open , Shanahan et al report the results of a large cross-sectional study, which includes data from 65 662 Census tracts representing almost 90% of the US population, finding that neighborhood conditions and access to resources are significantly associated with life expectancy at birth. Using merged data from the Child Opportunity Index (COI) 2.0 and the Centers for Disease Control and Prevention US Small-Area Life Expectancy Estimates Project, the authors found a stepwise reduction in life expectancy as childhood opportunity decreased; life expectancy in Census tracts with very low opportunity was 7 years lower than in Census tracts with very high opportunity.…”

“…Fourth, Census tract boundaries may differ from how individuals perceive their neighborhoods, which should be considered as interventions focused on health disparities are developed and implemented. These limitations notwithstanding, Shanahan et al should be applauded for their equity-focused evaluation of children’s life expectancy in the US and their contribution to the growing body of literature on health disparities.…”