Effect of neighborhood environment and individual social integration on mortality risk: an analysis of the Third National Health and Nutrition Examination Survey (NHANES III)

Background: Neighborhood socioeconomic condition and individual social integration are social constructs that have been independently linked to health. A decline in neighborhood condition has been linked to increased risks of poor health and mortality while social isolation has been shown to have similar risks. The goal of this study was to evaluate the association between these two known social determinants of health. This was achieved through three projects with the following objectives: 1) to evaluate the relationship between neighborhood socioeconomic context and distinct forms of social integration, 2) to examine whether neighborhood socioeconomic context influences time-to-death within this sample while controlling for confounders, and 3) to explore whether neighborhood socioeconomic context and social integration together have an impact on time-to-death. METHODS: The present study used data from the Third National Health and Examination Survey (NHANES III) and the NHANES III Linked Mortality File geocoded according to participants’ residential address and matched to Census data. A measure of neighborhood poverty that examined the proportion of residents in a census tract living below the federal poverty line was used to account for neighborhood context and a modified-Social Network Index was used to measure social integration. Logistic regression and Cox proportional hazards were used to assess associations while controlling for confounding. Additive interaction between neighborhood poverty and social integration was also examined. All analyses accounted for the complex sample design and sample weights. RESULTS: When controlling for individual-level factors, living in high poverty neighborhoods was associated with 47% (95% confidence interval: 1.15, 1.88) greater odds of having a low score on the SNI when compared with those living in more affluent neighborhoods. Living in a low poverty neighborhood was associated with a lower mortality risk when compared to living in a high poverty (≥20%) neighborhood. Those in high poverty neighborhoods with low social integration scores had a 63% (95% confidence interval: 1.34, 1.96) greater mortality risk when compared to those in low poverty neighborhoods with high social integration scores. CONCLUSION: The results of this dissertation provide evidence of the associations between neighborhood context, social integration and mortality.Ph. D.Includes bibliographical referencesby Andrea Fleisch Marcu