Faculty Collaboration Database

The health implications of cumulative exposure to contextual (dis)advantage: methodological and substantive advances from a unique data linkage. Am J Epidemiol 2025 Feb 05;194(2):480-489

Date

07/08/2024

Pubmed ID

38973742

Pubmed Central ID

PMC11815491

DOI

10.1093/aje/kwae183

Scopus ID

2-s2.0-85217882845 (requires institutional sign-in at Scopus site)   3 Citations

Abstract

Deleterious neighborhood conditions are associated with poor health, yet the health impact of cumulative lifetime exposure to neighborhood disadvantage is understudied. Using up to 5 decades of residential histories for 4177 adult participants in the Survey of the Health of Wisconsin (SHOW) and spatiotemporally linked neighborhood conditions, we developed 4 operational approaches to characterizing cumulative neighborhood (dis)advantage over the life course. We estimated their associations with self-reported general health and compared them with estimates using neighborhood (dis)advantage at the time of study enrollment. When cumulative exposures were assessed with the most granular temporal scale (approach 4), neighborhood transportation constraints (odds ratio [OR] = 1.21; 95% CI, 1.08-1.36), residential turnover (OR = 1.20; 95% CI, 1.07-1.34), education deficit (OR = 1.17; 95% CI, 1.04-1.32), racial segregation (OR = 1.20; 95% CI, 1.04-1.38), and median household income (OR = 0.85; 95% CI, 0.75-0.97) were significantly associated with risk of fair or poor health. For composite neighborhood disadvantage, cumulative exposures had a stronger association (OR = 1.05; 95% CI, 1.02-1.08) than the cross-sectional exposure (OR = 1.03; 95% CI, 1.01-1.06). Single-point-in-time neighborhood measures underestimate the relationship between neighborhood and health, underscoring the importance of a life-course approach to cumulative exposure measurement.

Author List

Xu W, Kamis C, Agnew M, Schultz A, Salas S, Malecki K, Engelman M

Author

Wei Xu PhD Assistant Professor in the Institute for Health and Humanity department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Female
Health Status
Health Status Disparities
Health Surveys
Humans
Male
Middle Aged
Residence Characteristics
Social Segregation
Socioeconomic Factors
Wisconsin