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Neighborhood Disadvantage and Life Expectancy in the United States (307909)

Kristen Berg, MetroHealth and CWRU 
Claudia Coulton, CWRU 
Jarrod Dalton, Cleveland Clinic 
Neal Dawson, CWRU 
Douglas Einstadter, MetroHealth and CWRU 
Darcy Freedman, CWRU 
Douglas Gunzler, MetroHealth and CWRU 
Nik Krieger, Cleveland Clinic 
Scott Moore, CWRU 
*Adam T Perzynski, MetroHealth and CWRU 

Keywords: neighborhood, small area estimation, social determinants, area deprivation, US Census

Growing evidence demonstrates that neighborhood conditions influence health outcomes via complex pathways. No prior study has examined the composite influence of conditions of neighborhood disadvantage on life expectancy (LE) in the United States. Data for all United States Census Tracts from the 2009 American Community Survey were compiled into the Area Deprivation Index (ADI) using the sociome R package. The ADI includes housing, vehicle access, poverty, family structure, education, and employment (Singh, 1993). LE at birth 2010-2015 was drawn from the US Small-Area Life Expectancy Estimates Project. Nonlinear regression was used to estimate aggregate and state-level associations between ADI and LE. Tract level ADI ranged from 40.7 to 188.2 (median 98.4, IQR [86.1, 111.8]), and LE ranged from 59.5 to 96.1 (median 78.4, IQR [75.6, 81.0]). Overall, a quadratic relationship between ADI and LE was significant (p < 0.001); this relationship significantly varied among the states (p < 0.001; multiple R-squared = 0.55). These results suggest that place-based disadvantages are a fundamental determinant of differences in life expectancy with notable state-level differences.