Neighborhood Disadvantage in a Nationally Representative Sample of Community-Living Older US Adults
Authors: Thomas M. Gill, Linda Leo-Summers, Brent Vander Wyk, Robert D. Becher, Jingchen Liang
Journal: JAMA Network Open (2024)

Importance Although neighborhood socioeconomic disadvantage has become the standard for evaluating contextual socioeconomic deprivation at the Census-block level, little is known about its prevalence or association with long-term mortality in nationally representative samples of older persons. Objectives To estimate the prevalence of neighborhood disadvantage among a nationally representative sample of community-living older adults; to identify how prevalence estimates differ based on relevant demographic, socioeconomic, geographic, clinical, and geriatric characteristics; and to evaluate the association between neighborhood disadvantage and all-cause mortality. Design, Setting, and Participants This cohort study analyzed linked data of community-living persons aged 65 years or older in the contiguous US participating in the National Health and Aging Trends Study (NHATS) from 2011 to 2021. Data on demographic, socioeconomic, geographic, clinical, and geriatric characteristics were obtained primarily from the baseline NHATS assessment. NHATS survey weights were used for all analyses. Data analysis was conducted from February to July 2024. Main Outcomes and Measures Neighborhood disadvantage—the main measure for each of the 3 objectives—was assessed using the area deprivation index, which was dichotomized at the worst quintile (defined as the worst 2 deciles). Ascertainment of mortality over 10 years was 100% complete. Results Among the 7505 participants, with a weighted mean (SD) age of 75.3 (7.4) years, 56.8% were female, 6.6% were Hispanic, 8.2% were non-Hispanic Black, and 81.7% were non-Hispanic White individuals. The prevalence of neighborhood disadvantage was 15.8% (95% CI, 14.9%-16.7%), but it differed greatly across multiple subgroups. The largest differences after adjustment for age and sex were observed for non-Hispanic Black compared with non-Hispanic White participants (rate ratio [RR], 3.11; 95% CI, 2.56-3.79); those with less than a high school diploma vs college degree or higher educational level (RR, 3.47; 95% CI, 2.75-4.39); and those in several Census divisions, with an RR as high as 7.31 (95% CI, 2.98-17.90) for West South Central vs Pacific. The mortality rates were 48.5% (95% CI, 44.6%-52.1%) and 43.5% (95% CI, 42.2%-44.7%) among participants in a disadvantaged and a nondisadvantaged neighborhood. Neighborhood disadvantage was associated with mortality after adjustment for demographic characteristics (hazard ratio [HR], 1.25; 95% CI, 1.11-1.40) but not after further adjustment for socioeconomic characteristics (HR, 1.11; 95% CI, 0.98-1.25). Conclusions and Relevance In this cohort study of community-living older adults, population-based estimates of neighborhood disadvantage differed greatly across multiple subgroups. This contextual indicator of socioeconomic deprivation was associated with long-term mortality, but the association was diminished and no longer significant after accounting for individual-level socioeconomic characteristics.