The influence of community socioeconomic status on North Carolinians' health related quality of life

Community socioeconomic status (SES) influences the social, service, and physical environments of a community regardless of one's own socioeconomic position, and can in turn positively or negatively affect individual-level health outcomes. This study investigated the influence of community SES on the health related quality of life (HRQOL) of North Carolinians. Secondary data analyses were conducted on a subset of Social Determinants of Health Study participants (N=1217) residing in 32 North Carolina communities. Community-level data came from two sources: publicly-available data sources for non-aggregated attributes (contextual) and the US Census 2000 for aggregated attributes (compositional). Contextual domains examined were: Shopping/Grocery, Restaurants/Fast-Food, Recreational Facilities, Medical Services, and Transportation; compositional community SES was: % individuals in a community living below poverty. The outcome variable was HRQOL: unhealthy days, physical functioning, and self-rated health. Qualitative methodology including data triangulation and quantitative (multi-level modeling) methods were used for data analysis. Participants living in communities with public transportation reported fewer unhealthy days (B= -2.796, p=.004), better physical functioning (B= 3.215, p=.002), and better self-rated health (B= .244, p=.007). Participants living in communities with higher rates of restaurants reported better self-rated health (B= .044, p=.007); participants in communities with higher rates of hospital beds reported worse self-rated health (B= -.010, p=.038). Greater community poverty was predictive of participants reporting fewer unhealthy days (B=-.181, p=.001), however the relationship strength diminished with the addition of contextual community resources (B=-.147, p=.017). Community poverty did not significantly predict physical functioning (B= .027, p=.685); yet participants living in communities with public transportation reported higher physical functioning scores (B=3.052, p=.006). Community poverty did not significantly predict self-rated health; however participants reported better self-rated health if they lived in communities with public transportation (B=.229, p=0.018) and a higher rate of restaurants (B= .041, p=0.016), yet greater rate of community hospital beds predicted worse self-rated health (B= -.011, p=0.034). Healthy People 2010 and 2020 goals affirm examining `lives in context' through multiple perspectives, including a biological, genetic, social and environmental context. Better understanding of community characteristics could have policy implications for resource allocation, city and urban planning, and future health interventions to improve HRQOL