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Article

No Man is an Island: The Impact of Neighborhood Disadvantage on Mortality

by
Darrell J. Gaskin
1,2,*,
Eric T. Roberts
3,
Kitty S. Chan
2,4,
Rachael McCleary
1,2,
Christine Buttorff
5 and
Benjo A. Delarmente
1,2
1
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
2
Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
3
Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health; Pittsburgh, PA 15261, USA
4
MedStar-Georgetown Surgical Outcomes Research Center, MedStar Health Research Institute and Medstar Georgetown University Hospital, Washington, DC 20007, USA
5
RAND Corporation, Arlington, VA 22202, USA
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(7), 1265; https://doi.org/10.3390/ijerph16071265
Submission received: 8 February 2019 / Revised: 15 March 2019 / Accepted: 27 March 2019 / Published: 9 April 2019
(This article belongs to the Special Issue Health Care Equity)
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Abstract

This study’s purpose is to determine if neighborhood disadvantage, air quality, economic distress, and violent crime are associated with mortality among term life insurance policyholders, after adjusting for individual demographics, health, and socioeconomic characteristics. We used a sample of approximately 38,000 term life policyholders, from a large national life insurance company, who purchased a policy from 2002 to 2010. We linked this data to area-level data on neighborhood disadvantage, economic distress, violent crime, and air pollution. The hazard of dying for policyholders increased by 9.8% (CI: 6.0–13.7%) as neighborhood disadvantage increased by one standard deviation. Area-level poverty and mortgage delinquency were important predictors of mortality, even after controlling for individual personal income and occupational status. County level pollution and violent crime rates were positively, but not statistically significantly, associated with the hazard of dying. Our study provides evidence that neighborhood disadvantage and economic stress impact individual mortality independently from individual socioeconomic characteristics. Future studies should investigate pathways by which these area-level factors influence mortality. Public policies that reduce poverty rates and address economic distress can benefit everyone’s health.
Keywords: social determinants; health; neighborhood disadvantage; mortality; socioeconomic status social determinants; health; neighborhood disadvantage; mortality; socioeconomic status

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MDPI and ACS Style

Gaskin, D.J.; Roberts, E.T.; Chan, K.S.; McCleary, R.; Buttorff, C.; Delarmente, B.A. No Man is an Island: The Impact of Neighborhood Disadvantage on Mortality. Int. J. Environ. Res. Public Health 2019, 16, 1265. https://doi.org/10.3390/ijerph16071265

AMA Style

Gaskin DJ, Roberts ET, Chan KS, McCleary R, Buttorff C, Delarmente BA. No Man is an Island: The Impact of Neighborhood Disadvantage on Mortality. International Journal of Environmental Research and Public Health. 2019; 16(7):1265. https://doi.org/10.3390/ijerph16071265

Chicago/Turabian Style

Gaskin, Darrell J., Eric T. Roberts, Kitty S. Chan, Rachael McCleary, Christine Buttorff, and Benjo A. Delarmente. 2019. "No Man is an Island: The Impact of Neighborhood Disadvantage on Mortality" International Journal of Environmental Research and Public Health 16, no. 7: 1265. https://doi.org/10.3390/ijerph16071265

APA Style

Gaskin, D. J., Roberts, E. T., Chan, K. S., McCleary, R., Buttorff, C., & Delarmente, B. A. (2019). No Man is an Island: The Impact of Neighborhood Disadvantage on Mortality. International Journal of Environmental Research and Public Health, 16(7), 1265. https://doi.org/10.3390/ijerph16071265

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