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News — Living in a neighborhood with high unemployment rates, poor housing, low school quality, or poverty has been shown to have significant implications for residents’ health and well-being. Yet, little is known about the impact of neighborhood socioeconomic disadvantage on the long-term mortality of older adults, especially in nationally representative populations.

In a new study, Yale School of Medicine (YSM) researchers examined how the prevalence of neighborhood disadvantage differed according to individual-level characteristics and evaluated the association between neighborhood disadvantage and mortality among older people over the course of 10 years.

“While individual-level predictors such as age, sex, and comorbid conditions have been well-studied, less is known about the contextual social determinants of health, meaning the environment—or, in this case, the neighborhood—in which you live,” said , Humana Foundation Professor of Medicine (Geriatrics) at YSM and professor of epidemiology (chronic diseases) at the Yale School of Public Health, who is corresponding author of the study. “We wanted to expand the scope of work that’s been done in this space.”

For the study,  today, researchers used data from the National Health and Aging Trends Study (NHATS) to determine the prevalence of neighborhood disadvantage among 7,505 community-living older adults in the continental United States. They found a value of 15.6 percent. This research was funded by the National Institute of Minority Health and Health Disparities and conducted within the .

The researchers then examined how the prevalence of neighborhood disadvantage differs among subgroups based on demographic, socioeconomic, clinical, and geographic factors.

Gill pointed to certain geographic areas, such as Mississippi and Alabama, that were more likely to be disadvantaged than other areas of the United States. He noted that people with frailty were two times more likely to reside in a disadvantaged neighborhood and that individuals who did not complete high school were three and a half times more likely.

While the researchers found that neighborhood disadvantage was associated with an 18 percent increase in mortality over 10 years, this association was no longer statistically significant after adjusting for participant socioeconomic characteristics.

The researchers had previously published reports on neighborhood disadvantage in a cohort of older adults in Southern Connecticut. Using data from NHATS allowed them to draw broader conclusions from a nationally representative sample of Medicare beneficiaries age 65 and older, Gill said.

Many individuals have characteristics that put them at risk for adverse health outcomes that are indicators of disadvantage, Gill said. “In addition, they may live in disadvantaged neighborhoods, and together that probably accentuates their risk for adverse outcomes,” he added.

, YSM associate professor of surgery (general, trauma, and surgical critical care) and co-author, emphasized the study's importance in adding to the research team’s evidence about the impact of contextual-level social determinants of health.

“In this case, neighborhood disadvantage can have significant downstream consequences in the lives of older adults,” he said. 

Other authors of the study include , , and . Research reported in this release was supported by National Institute on Minority Health and Health Disparities under award number R01MD017298 and from the National Institute on Aging under award number P30AG021342 with 0% nongovernmental funding. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

About Yale School of Medicine

Yale School of Medicine educates leaders in medicine and science, fostering curiosity and critical inquiry in a diverse, inclusive environment. It is a global leader in biomedical research, clinical care, and medical education, ranking fourth in NIH funding and tenth in NIH dollars per faculty member. With over 1,700 physicians, Yale provides compassionate care to patients worldwide. The Yale System of Medical Education emphasizes critical thinking and independent research, producing leaders in academic medicine.