183501 Health effects of a local area racial residential segregation measure on aging adults

Monday, October 27, 2008: 12:50 PM

Joseph Sudano, PhD , Center for Health Care Research and Policy, Case Western Reserve University at the MetroHealth System, Cleveland, OH
Natalie Colabianchi, PhD , Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
David W. Wong, PhD , Earth Systems & GeoInformation Sciences, George Mason University, Fairfax, VA
David Litaker, MD, PhD , School of Medicine, Department of Epidemiology & Biostatistics, Louis Stokes VA, Case Wesern Reserve University, Cleveland, OH
     
BACKGROUND: Racial residential segregation (RRS) is associated with community-level mortality rates, yet its relationship with individual-level mortality and health declines is less clear. We measured this association's strength controlling for individual-level characteristics that may confound/mediate this relationship.

METHODS: Cohort study, using longitudinal data collected between 1992-2000 in the Health and Retirement Study (HRS), a large, nationally representative survey of adults 51-61 years of age in 1992. Using respondents' addresses, we calculated the Location Quotient (LQ), a census tract-based segregation measure, and categorized it as low, medium, or high. Nested multivariable regression models estimated adjusted relative risks (ARR) of LQ for health declines (major decline in self-reported health or death 1992-2000), controlling for individuals' demographic characteristics, health measures and behaviors, socioeconomic status, and insurance coverage.

RESULTS: Of 6,658 adults, 5011 lived in low, 849 in medium, and 798 in high LQ tracts in 1992. Major decline/death rates were 20.5% in low LQ tracts, 30.2%, and 31.7% in medium and high tracts, respectively (p<0.001). Adjusting for demographic characteristics, medium and high LQ were as associated with greater likelihood of major decline/death: medium ARR=1.35 (95% CI 1.28, 1.42; p<.001) and high ARR=1.34 (95% CI 1.21, 1.28; p<.001). Controlling for all other variables, LQ predicted major decline/death: medium ARR=1.15 (95% CI 1.08, 1.23; p<.001) and high ARR=1.13 (95% CI 1.02, 1.26; p<.02).

CONCLUSION: Individual characteristics mediated some, but not all the association between segregation and worse health outcomes. The effects of RRS on health should be studied more closely to better inform policy solutions.

Learning Objectives:
1. Describe and calculate a local area segregation measure that has rarely been used in social epidemiology and interpret its values. 2. List 5 sets of factors that may moderate or confound the effect of segregation on health outcomes and articulate the specific variables within each set of factors. 3. Discuss alternative interpretations, limitations, and further steps in future studies and policy implications for public health systems (if any).

Keywords: Health Disparities, Community

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Research on this topic for many years, published using this dataset and did the analysis for this abstract.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Social Epidemiology I
See more of: Epidemiology