Relationship of neighborhood and individual socioeconomic status on mortality among older adults: Evidence from cross-level interaction analyses

Abstract

Background The influence of community context and individual socioeconomic status on health is widely recognized. However, the dynamics of how the relationship of neighborhood context on health varies by individual socioeconomic status is less well understood. Objective To examine the relationship between neighborhood context and mortality among older adults and examine how the influence of neighborhood context on mortality differs by individual socioeconomic status, using two measures of income-level and homeownership. Research design and subjects A retrospective study of 362,609 Medicare Advantage respondents to the 2014–2015 Medicare Health Outcomes Survey aged 65 and older. Measures Neighborhood context was defined using the deciles of the Area Deprivation Index. Logistic regression was used to analyze mortality with interaction terms between income/homeownership and neighborhood deciles to examine cross-level relationships, controlling for age, gender, race/ethnicity, number of chronic conditions, obese/underweight, difficulties in activities of daily living, smoking status, and survey year. Predicted mortality rates by group were calculated from the logistic model results. Results Low-income individuals (8.9%) and nonhomeowners (9.1%) had higher mortality rates compared to higher-income individuals (5.3%) and homeowners (5.3%), respectively, and the differences were significant across all neighborhoods even after adjustment. With regression adjustment, older adults residing in less disadvantaged neighborhoods showed lower predicted 2-year mortality among high-income (4.86% in the least disadvantaged neighborhood; 6.06% in the most disadvantaged neighborhood; difference p-value<0.001) or homeowning individuals (4.73% in the least disadvantaged neighborhood; 6.25% in the most disadvantaged neighborhood; difference p-value<0.001). However, this study did not observe a significant difference in predicted mortality rates among low-income individuals by neighborhood (8.7% in the least disadvantaged neighborhood; 8.61% in the most disadvantaged neighborhood; difference p-value = 0.825). Conclusions Low-income or non-homeowning older adults had a higher risk of mortality regardless of neighborhood socioeconomic status. While living in a less disadvantaged neighborhood provided a protective association for higher-income or homeowning older adults, low-income older adults did not experience an observable benefit.

Promotion of Healthy Lifestyles Alone Might Not Substantially Reduce Socioeconomic Inequity-Related Mortality Risk in Older People in China: A Prospective Cohort Study

“…In the present study, we observed significant mortality inequity by SES for older people, which were in line with these of past research [32][33][34][35][36]. To name a few examples, Bassuk et al demonstrated that higher SES, as measured by education, by household income, or by occupational prestige, was generally associated with lower mortality in four American community-dwelling populations aged 65 years or more [32].…”

“…To name a few examples, Bassuk et al demonstrated that higher SES, as measured by education, by household income, or by occupational prestige, was generally associated with lower mortality in four American community-dwelling populations aged 65 years or more [32]. Using the data from the 2014 to 2015 Medicare Health Outcomes Survey, Kim revealed that mortality rates were significantly higher in lowincome elders or non-homeowners when compared to their respective opposites [33]. Similarly, in another study consisted of 11 European populations, Huisman et al found persisted socioeconomic inequity in mortality among older men and women, and the SES in this study was indicated by educational level or housing tenure [34].…”

The relationship between health and housing in low‐income older adults: A secondary analysis of survey data

“…Comparisons of the low-income and higher-income groups indicated that, similar to findings in other investigations, adults in the low-income group were more likely to be in poor health (Kim et al, 2022;Park et al, 2017), live alone (Li & Dalaker, 2022), and have problems with housing quality and affordability (Kwon & Jang, 2017;Lee et al, 2014) and concerns about neighborhood safety (Kowitt et al, 2020;Park et al, 2017). At the same time, regression analyses indicated that for both the low-income and higher-income groups, health was significantly related to housing quality, household size, and neighborhood safety, suggesting that housing is a health determinant that crosses income boundaries.…”

Area Socioeconomic Status is Associated with Refusal of Recommended Surgery in Patients with Metastatic Bone and Joint Disease

“… 57 – 60 Lower neighborhood socioeconomic status has been linked to increased mortality risk. 61 , 62 There is strong evidence in literature that moving from high-poverty to lower-poverty neighborhoods can have a positive long-term effect on mental and physical well-being. 63 Lower nSES also has been associated with decreased mental health and reduced cognitive function.…”