Effects on health and health inequalities of time-sensitive and prolonged exposure to neighborhood disadvantage

Background: Studies of neighborhoods and health often rely on cross-sectional data in which effects are assumed, at least implicitly, to be instantaneous and equivalent across the lifecourse. However, point-in-time measurements may substantially underestimate the lasting effects of time-sensitive or prolonged exposure to neighborhood disadvantage earlier in life. Objective: This study utilizes 40+ years of data to investigate effects of timing and duration of exposure to neighborhood disadvantage throughout childhood and adolescence on health and health inequalities in early adulthood. Methods: Respondents include approximately 2,500 individuals born between 1970 and 1980 from the Panel Study of Income Dynamics. Annual measurements of neighborhood disadvantage are derived from the Neighborhood Change Database. Marginal structural models with inverse-probability-of-treatment weights are used to adjust for time-varying covariates, such as income, homeownership and family size, which may simultaneously confound and mediate the basic neighborhood-health relationship. Results: Preliminary analyses suggest dramatic black-white disparities in age-specific and cumulative exposure to neighborhood disadvantage throughout childhood and adolescence (e.g. 34% of blacks vs. 3% of whites spend most of childhood in the most disadvantaged neighborhoods). Average causal effects of exposure to neighborhood disadvantage during three developmental periods (ages 0-5, 6-11 and 12-17) and cumulatively from ages 0-17 are estimated for various adult health outcomes, including self-rated health, body mass index, health behaviors, nonspecific psychological distress, and the birthweight of female respondents’ first child. Conclusions: Findings offer more nuanced insights into when and how early neighborhood disadvantage affects long-term health and persistent health inequalities. Implications for practice and policy are presented.