Explaining variation in health status across space and time: implications for racial and ethnic disparities in self-rated health

doi:10.1016/S0277-9536(02)00502-6

Social Science & Medicine

Volume 57, Issue 7, October 2003, Pages 1221-1235

https://doi.org/10.1016/S0277-9536(02)00502-6 Get rights and content

Abstract

We use the Metropolitan Community Information Center-Metro Survey—a serial cross section of adults residing in the City of Chicago, USA, conducted from 1991 through 1999—in combination with 1990 census data to simultaneously examine the extent to which self-rated health varies across Chicago neighborhoods and across time. Three-level hierarchical logit models are employed to decompose individual, spatial, and temporal variance in self-rated health. Results indicate that variation in self-rated health across neighborhoods is explained, in part, by variation in the level of neighborhood affluence. Neighborhood level poverty, however, is not a significant predictor of self-rated health. Community level affluence, moreover, accounts for a substantial proportion of the residual health deficit experienced by African-Americans when compared with Whites (after controlling for individual level SES). The effects of affluence hold when controlling for spatial autocorrelation and when considered in primarily African-American neighborhoods. Findings also indicate that individuals living in the City of Chicago became significantly healthier over the decade of the 1990s, and that this improvement in health is explained largely by the increasing education and income levels of Chicago residents.

Section snippets

Neighborhood structural context and health

In what follows, we develop a theoretical model that articulates the role of neighborhood socioeconomic resources in contributing to the health of urban residents above and beyond individual socioeconomic status. As noted, we emphasize the macro-level presence of resources as the critical structural antecedent in the link between neighborhood context and health. This theoretical focus is distinguished from the typical emphasis on the prevalence of disadvantage. We root this focus in Wilson's

Data and methods

We use two data sources in this analysis: the 1990 Decennial Census and the 1991–1999 Metropolitan Chicago Information Center Metro Survey (MCIC-MS). Neighborhood structural characteristics are constructed from census data and include measures of poverty, affluence, residential stability, and immigrant concentration (described below). Neighborhood measures are constructed for 342 “Neighborhood clusters” (NCs)—aggregations of two to three census tracts designed to more accurately represent the

Analytic strategy

We use three-level hierarchical logit models (Raudenbush & Bryk, 2002; Snijders & Bosker, 1999) in order to decompose the variance in self-rated health into individual, temporal, and spatial components. This strategy allows us to simultaneously assess the extent to which health varies across individuals (within neighborhoods and time points), time (within neighborhoods), and neighborhoods (across space). By employing a three-level approach, we also ensure that conclusions regarding neighborhood

Results

Table 2 reports the results of three-level hierarchical logit models of self-rated health. Model 1 reports the results of the unconditional three-level model.¹²

Discussion

Race and ethnic differences in health status have occupied considerable research attention in recent decades. While the hypothesis that discrepancies in socioeconomic resources at the individual level has helped explain a proportion of the race/ethnic health gap, evidence suggests that individual level SES alone cannot fully account for the persistent disparities in health between Whites and African American and Latino minorities. Extending the work of Cagney et al. (2002) on elderly urban

Acknowledgements

Thanks to Garth Taylor and the Metropolitan Community Information Center for use of the Metro Survey data. Thanks to Angelo Alonzo, Willard Manning, and Robert Dietz for their helpful comments.

References (70)

C. Duncan et al.
Do places matterA multilevel analysis of regional variations in health related behaviour in Britain
Social Science & Medicine
(1993)
K. Jones et al.
Individuals and their ecologiesAnalyzing the geography of chronic illness within a multilevel modelling framework
Health & Place
(1995)
V. Lorant et al.
Deprivation and mortalityThe implications of spatial autocorrelation for health resources allocation
Social Science & Medicine
(2001)
Luc. Anselin
Spatial econometricsmethods and models
(1988)
Y. Benyamini et al.
Community studies reporting association between self-rated health and mortality
Research on Aging
(1999)
Browning, C.R., & Cagney, K.A. (2002). Neighborhood structural disadvantage, collective efficiency and self-rated...
Cagney, K.A., Browning, C.R., & Wen, M. (2002). Race and self-rated health at older ages: what difference does the...
P.L. Chase-Lansdale et al.
Neighborhood and family influences on the intellectual and behavioral competence of preschool and early school-age children
G. Davey Smith et al.
Individual social class, area-based deprivation, cardiovscular disease risk factors, and mortalityThe Renfrew and paisley study
Journal of Epidemiology Community Health
(1998)
A.V. Diez-Roux et al.
Neighborhood environments and coronary heart diseaseA multilevel analysis
American Journal of Epidemiology
(1997)

C. Duncan et al.

Psychiatric morbidity; a multilevel approach to regional variations in the UK

Journal of Epidemiology and Community Health

(1995)

G.J. Duncan et al.

Assessing the effects of context in studies of child and youth development

Educational Psychologist

(1999)

Earls, F., & Buka, S. L. (1997). Project on Human Development in Chicago Neighborhoods: Technical Report. National...

S. Elreedy et al.

Relations between individual and neighborhood-based measures of socioeconomic position and bone lead concentrations among community-exposed menThe normative aging study

American Journal of Epidemiology

(1999)

K.F. Ferraro et al.

Health trajectoriesLong-term dynamics among black and white adults

Journal of Health and Social Behavior

(1997)

B.K. Finch et al.

Validity of self-rated health among Latino(a)s

American Journal of Epidemiology

(2002)

K. Fitzpatrick et al.

Unhealthy placesThe ecology of risk in the urban landscape

(2000)

R.C. Gibson

Race and the self-reported health of elderly persons

Journal of Gerontology: Social Sciences

(1991)

M. Goldstein et al.

Predicting changes in perceived self-reported health status

American Journal of Public Health

(1984)

D.A. Griffith et al.

A tale of two swathsUrban childhood blood-lead levels across Syracuse

Annals of the Association of American Geographers

(1998)

M. Haan et al.

Poverty and healthProspective evidence from the alameda county study

American Journal of Epidemiology

(1987)

J. House et al.

Understanding and reducing socioeconomic and racial/ethnic disparities in health

C.K. Hsiao

Comparing the performance of two indices for spatial model selectionApplication to two mortality data 1

Statistical Medicine

(2000)

K. Humphreys et al.

Area variations in health outcomesArtefact or ecology

International Journal of Epidemiology

(1991)

E.L. Idler et al.

Self-ratings of healthDo they also predict change in functional ability?

Journal of Gerontology Social Science

(1995)

E.L. Idler et al.

Self-rated health and mortalityA review of twenty-seven community studies

Journal of Health and Social Behavior

(1997)

E.L. Idler et al.

Self-rated health and mortality in the NHANES-1 Epidemiologic Follow-up Study

American Jounal of Public Health

(1990)

R.J. Johnson et al.

Gender, race, and healthThe structure of health status among older adults

The Gerontologist

(1994)

G.A. Kaplan et al.

Socioeconomic factors and cardiovascular diseaseA review of the literature

Circulation

(1993)

G.A. Kaplan et al.

Social connections and mortality from all causes and cardiovascular diseaseProspective evidence from eastern Finland

American Journal of Epidemiology

(1988)

J.D. Kasarda et al.

Community attachment in mass society

American Sociological Review

(1974)

I. Kawachi et al.

Social cohesion, social capital, and health

I. Kawachi et al.

Income inequality and healthPathways and mechanisms

Health Services Research

(1999)

I. Kawachi et al.

Social capital, income inequality, and mortality

American Journal of Public Health

(1997)

R. Kington et al.

Socioeconomic status and racial and ethnic differences in functional status associated with chronic diseases

American Jounal of Public Health

(1997)

Cited by (83)

Neighborhood cohesion and psychological distress across race and sexual orientation
2022, SSM - Population Health
We investigate the association neighborhood cohesion, as source of social support, has with psychological distress among white, Black, and Latinx lesbian, gay, and bisexual (LGB) individuals, compared to heterosexual individuals in the United States.
We estimate zero-order multinomial logistic regression models to assess the likelihood of moderate and severe psychological distress among respondents.
In the models accounting for neighborhood cohesion and all other covariates, white, Black, and Latinx lesbian, gay, and bisexual individuals are more likely to meet the criteria for moderate and severe psychological distress than non-LGB people.
Neighborhood cohesion has differing impact on psychological distress outcomes by racial/ethnic-sexual orientation groups, but in general provides a greater magnitude of protection against moderate psychological distress for non-LGB groups and a greater magnitude of protection against severe psychological distress for LGB groups.
Uses of theory in racial health disparities research: a scoping review and application of public health critical race praxis
2022, Annals of Epidemiology
Given the persistence of racial health disparities, scholars have called for investigations into structural origins of health inequity and deeper engagement with theory. We systematically assessed uses of theory—including theory informed conceptualizations of race and ethnicity, social structure, and racial hierarchy—in epidemiology and other quantitative population health literature on racial health disparities.
We conducted a scoping review of systematically identified original research articles (n=650) that sought to explain racial health disparities; articles were published in 17 high-impact epidemiology, public health, and social science journals. Trained coders abstracted data from each article. We applied Public Health Critical Race Praxis and an iterative data-charting method to identify key themes.
Only 63 (9.7%) of 650 racial health disparities articles explicitly used theory. Among studies that engaged theory, one third (n=21/63) clearly conceptualized race and/or ethnicity, and a minority theorized social structure (n=19/63; 30%) and/or racial hierarchy as a structural relation (n=4/63; 6%).
There is a pressing need for racial health disparities researchers to unambiguously use theory to conceptualize race and ethnicity in social and historical contexts and explain relational aspects of racial hierarchy. These approaches can better elucidate and inform action on structural determinants of both racial inequity and racial health inequity.
Shifting neighborhoods, shifting health: A longitudinal analysis of gentrification and health in Los Angeles County
2021, Social Science Research
Citation Excerpt :
In an effort to ensure that the observed relationship between duration of exposure to gentrification and increased health is not a spurious one related to the positive effects of remaining in a neighborhood for long periods of time, I explore the relationship between duration of exposure to stable, low-SES neighborhoods and self-reported health. I use stable low-SES neighborhoods, rather than stable middle- or high-SES neighborhoods, primarily because extant research finds that residence in more affluent neighborhood is linked with greater self-rated health (Browning et al., 2003; Wen et al., 2003). Testing the link between remaining in a stable neighborhood and health is also preferable to analyzing the health of residents in declining tracts, largely because if the neighborhood is experiencing decline on a number of dimensions, there may also be forces at play within the neighborhood that are negatively linked to health.
Gentrification is characterized by an influx of capital, built environment upgrades, and physical and social displacement of residents and institutions. The numerous, relatively rapid transitions that occur during gentrification make accounting for duration of exposure to gentrification particularly important when exploring its relationship to health. Though a large literature explores how timing and duration of exposure to relatively stable neighborhood conditions are linked to health, little is known about how exposure to gentrification is linked to the health of longtime residents. Using restricted, longitudinal data from the Los Angeles Family and Neighborhood Survey, I ask (1) how is duration of exposure to gentrification linked to the self-reported health of those who remain in the neighborhood? (2) How does this relationship vary for members of different racial and ethnic groups? Results indicate that the longer an individual lives in a gentrifying neighborhood, the better their self-reported health. The results do not vary by race or ethnicity. The results of this study are not an endorsement of the use of gentrification as a public health intervention, as previous work finds that gentrification can also be associated with social, physical, and institutional displacement. Instead, findings reiterate the importance of neighborhood investments for the health and well-being of their residents over time.
Structural racism, economic opportunity and racial health disparities: Evidence from U.S. counties
2020, SSM - Population Health
In this study, we introduce the ‘racial opportunity gap’ as a place-based measure of structural racism for use in population health research. We first detail constructing the opportunity gap using race-sex specific estimates of intergenerational economic mobility outcomes for a recent cohort. We then illustrate its utility in examining spatial variation in the racial mortality gap. First we demonstrate a correlation between the racial opportunity gap and the racial mortality gap across U.S. counties; where the gap in the adult earnings of black and white children born to families at the same income level is greater so, too, is the gap in mortality. Second, we show in a multivariable framework that the racial opportunity gap is associated with the racial mortality gap net of differences in the socioeconomic composition of the two groups. In so doing, we aim to provide population health researchers with a new empirical tool and analytic framework for examining the role of structural racism in generating racial health disparities.
Neighbourhood influence on the fourth dose of diphtheria-tetanus-pertussis vaccination
2019, Public Health
Citation Excerpt :
Targeted interventions for both types of tract populations could prevent childhood disease and increase coverage of DTaP4 and possibly other vaccines. Often studies only investigate neighbourhood poverty or disadvantage and not affluence as a determinant of health, which limits inference at the neighbourhood level.22,30 Our analysis demonstrates these two social constructs are indeed independent within the neighbourhood socio-economic environment and should be considered separately by health professionals when determining targeted neighbourhood-level interventions for vaccinations.
Using 542,159 vaccination records from children born between April 1, 2007, and March 31, 2012, in the Michigan Care Improvement Registry and data from the American Community Survey, we determine if neighbourhood-level characteristics at the Census tract level and block level are associated with low uptake of the fourth dose of diphtheria–tetanus–acellular pertussis vaccine (DTaP4).
This study was a cross-sectional study.
We used exploratory factor analysis to determine important socio-economic factors at the Census block level and tract level. We then used generalised estimating equations to test the relationship between block- and tract-level socio-economic factors and DTaP4 uptake.
DTaP4 coverage was 88.6% (95% confidence interval [CI]: 88.4%–88.7%) in Michigan. At the Census tract level, two factors surfaced as important for DTaP4 vaccination: ‘affluence’ (Cronbach's alpha = 0.88) and ‘socio-economic disadvantage’ (Cronbach's alpha = 0.89). At the Census block level, one factor was important: ‘affluence’ (Cronbach's alpha = 0.90). Affluence may relate to knowledge about medical exemptions and antivaccination sentiment, while socio-economic disadvantage may indicate limited access to healthcare resources. Children in high-affluence tracts had 1.08% lower vaccination coverage (95% CI: −1.62% to −0.55%) than children in low affluence tracts. Children in low socio-economic disadvantage tracts had 2.92% higher coverage than children in high socio-economic disadvantage tracts (95% CI: 2.58%–3.26%).
This study articulates the need to further understand the contribution of neighbourhood-level characteristics, from both affluent and socioeconomically disadvantaged areas to low vaccination rates. Developing a better understanding of these social environmental factors will help determine useful community-level interventions to improve vaccination rates and reduce disease burden.
Ethnic enclaves and birth outcomes of immigrants from India in a diverse U.S. state
2018, Social Science and Medicine
Sociological theory suggests that ethnic enclaves promote immigrant health. Existing studies of ethnic enclaves and immigrant birth outcomes have generally focused on blacks and Hispanics, while few have focused on immigrants from India — the second largest immigrant group in the U.S., after Mexicans. Paradoxically, this group generally exhibits worse birth outcomes than non-Hispanic whites, despite their high levels of education. This study investigates associations between residence in South Central Asian ethnic enclaves and both birth outcomes and prenatal behaviors of immigrant mothers from India, using population-level birth record data from the state of New Jersey in the U.S. (1999–2012; n = 64,375). Results indicate that residence in a South Central Asian enclave is associated with less prenatal smoking and earlier prenatal care, but not with birthweight- or gestational-age related outcomes, among immigrant mothers from India. These findings are consistent with theory suggesting that social support, social capital, and social norms transmitted through the social networks present in ethnic enclaves foster health-promoting behaviors. Notably, the prenatal behaviors of non-Hispanic white mothers were not associated to a large degree with living in South Central Asian enclaves, which is also consistent with theory and bolsters our confidence that the observed associations for immigrant mothers from India are not spurious.

View all citing articles on Scopus

View full text

Explaining variation in health status across space and time: implications for racial and ethnic disparities in self-rated health

Abstract

Section snippets

Neighborhood structural context and health

Data and methods

Analytic strategy

Results

Discussion

Acknowledgements

Social Science & Medicine

Health & Place

Social Science & Medicine

Spatial econometricsmethods and models

Community studies reporting association between self-rated health and mortality

Research on Aging

Neighborhood and family influences on the intellectual and behavioral competence of preschool and early school-age children

Individual social class, area-based deprivation, cardiovscular disease risk factors, and mortalityThe Renfrew and paisley study

Journal of Epidemiology Community Health

Neighborhood environments and coronary heart diseaseA multilevel analysis

American Journal of Epidemiology

Psychiatric morbidity; a multilevel approach to regional variations in the UK

Journal of Epidemiology and Community Health

Assessing the effects of context in studies of child and youth development

Educational Psychologist

Relations between individual and neighborhood-based measures of socioeconomic position and bone lead concentrations among community-exposed menThe normative aging study

American Journal of Epidemiology

Health trajectoriesLong-term dynamics among black and white adults

Journal of Health and Social Behavior

Validity of self-rated health among Latino(a)s

American Journal of Epidemiology

Unhealthy placesThe ecology of risk in the urban landscape

Race and the self-reported health of elderly persons

Journal of Gerontology: Social Sciences

Predicting changes in perceived self-reported health status

American Journal of Public Health

A tale of two swathsUrban childhood blood-lead levels across Syracuse

Annals of the Association of American Geographers

Poverty and healthProspective evidence from the alameda county study

American Journal of Epidemiology

Understanding and reducing socioeconomic and racial/ethnic disparities in health

Comparing the performance of two indices for spatial model selectionApplication to two mortality data 1

Statistical Medicine

Area variations in health outcomesArtefact or ecology

International Journal of Epidemiology

Self-ratings of healthDo they also predict change in functional ability?

Journal of Gerontology Social Science

Self-rated health and mortalityA review of twenty-seven community studies

Journal of Health and Social Behavior

Self-rated health and mortality in the NHANES-1 Epidemiologic Follow-up Study

American Jounal of Public Health

Gender, race, and healthThe structure of health status among older adults

The Gerontologist

Socioeconomic factors and cardiovascular diseaseA review of the literature

Circulation

Social connections and mortality from all causes and cardiovascular diseaseProspective evidence from eastern Finland

American Journal of Epidemiology

Community attachment in mass society

American Sociological Review

Social cohesion, social capital, and health

Income inequality and healthPathways and mechanisms

Health Services Research

Social capital, income inequality, and mortality

American Journal of Public Health

Socioeconomic status and racial and ethnic differences in functional status associated with chronic diseases

American Jounal of Public Health