Relationship of neighborhood and individual socioeconomic status on mortality among older adults: Evidence from cross-level interaction analyses

• Published in: PloS one 2022-05, Vol.17 (5), p.e0267542-e0267542
• Main Author: Kim, Taehyun
• Format: Article
• Language: English
• Subjects: Activities of daily living; Adults; Aged; Angina pectoris; Beneficiaries; Biology and Life Sciences; Cardiovascular disease; Chronic conditions; Chronic illnesses; Community; Context; Deprivation; Earth Sciences; Economic aspects; Family income; Government programs; Health aspects; Health risks; Hispanic people; Home ownership; Households; Income; Logit models; Low income groups; Medicare; Medicine and Health Sciences; Mental health; Minority & ethnic groups; Mortality; Mortality risk; Neighborhoods; Older people; People and Places; Polls & surveys; Research and Analysis Methods; Research design; Social aspects; Social classes; Social Sciences; Socioeconomic factors; Socioeconomic status; Socioeconomics; Surveys; Underweight; Variables
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0267542

The influence of community context and individual socioeconomic status on health is widely recognized. However, the dynamics of how the relationship of neighborhood context on health varies by individual socioeconomic status is less well understood. To examine the relationship between neighborhood context and mortality among older adults and examine how the influence of neighborhood context on mortality differs by individual socioeconomic status, using two measures of income-level and homeownership. A retrospective study of 362,609 Medicare Advantage respondents to the 2014-2015 Medicare Health Outcomes Survey aged 65 and older. Neighborhood context was defined using the deciles of the Area Deprivation Index. Logistic regression was used to analyze mortality with interaction terms between income/homeownership and neighborhood deciles to examine cross-level relationships, controlling for age, gender, race/ethnicity, number of chronic conditions, obese/underweight, difficulties in activities of daily living, smoking status, and survey year. Predicted mortality rates by group were calculated from the logistic model results. Low-income individuals (8.9%) and nonhomeowners (9.1%) had higher mortality rates compared to higher-income individuals (5.3%) and homeowners (5.3%), respectively, and the differences were significant across all neighborhoods even after adjustment. With regression adjustment, older adults residing in less disadvantaged neighborhoods showed lower predicted 2-year mortality among high-income (4.86% in the least disadvantaged neighborhood; 6.06% in the most disadvantaged neighborhood; difference p-value