Health Status, Neighborhood Socioeconomic Context, and Premature Mortality in the United States: The National Institutes of Health–AARP Diet and Health Study

• DOI: 10.2105/ajph.2011.300158
• Publication Date: 2011-08-22T17:46:13Z
• Authors: Chyke A. Doubeni; Mario Schootman; Jacqueline M. Major; Rosalie A. Torres...; Adeyinka O. Laiyemo; Yikyung Park; Min Lian; Lynne Messer; Barry I. Graubard; Rashmi Sinha; Albert R. Hollenbeck; Arthur Schatzkin
• Keywords: Male; Health Status; Health Behavior; Diet Surveys; Cohort Studies; 03 medical and health sciences; 0302 clinical medicine; Residence Characteristics; Risk Factors; Surveys and Questionnaires; Humans; Prospective Studies; Mortality; Premature; Life Style; Primary Care; Aged; 2. Zero hunger; Mortality, Premature; 1. No poverty; Community Health and Preventive Medicine; Middle Aged; 16. Peace & justice; Health Surveys; Survival Analysis; United States; 3. Good health; National Institutes of Health (U.S.); Socioeconomic Factors; Chronic Disease; Female; Preventive Medicine

Objectives. We examined whether the risk of premature mortality associated with living in socioeconomically deprived neighborhoods varies according to the health status of individuals. Methods. Community-dwelling adults (n = 566 402; age = 50–71 years) in 6 US states and 2 metropolitan areas participated in the ongoing prospective National Institutes of Health–AARP Diet and Health Study, which began in 1995. We used baseline data for 565 679 participants on health behaviors, self-rated health status, and medical history, collected by mailed questionnaires. Participants were linked to 2000 census data for an index of census tract socioeconomic deprivation. The main outcome was all-cause mortality ascertained through 2006. Results. In adjusted survival analyses of persons in good-to-excellent health at baseline, risk of mortality increased with increasing levels of census tract socioeconomic deprivation. Neighborhood socioeconomic mortality disparities among persons in fair-to-poor health were not statistically significant after adjustment for demographic characteristics, educational achievement, lifestyle, and medical conditions. Conclusions. Neighborhood socioeconomic inequalities lead to large disparities in risk of premature mortality among healthy US adults but not among those in poor health.