TY - JOUR
T1 - The health implications of cumulative exposure to contextual (dis)advantage: Methodological and substantive advances from a unique data linkage
AU - Xu, Wei
AU - Kamis, Christina
AU - Agnew, Megan
AU - Schultz, Amy
AU - Salas, Sarah
AU - Malecki, Kristen
AU - Engelman, Michal
PY - 2024
Y1 - 2024
N2 - Deleterious neighborhood conditions are associated with poor health, yet the health impact of cumulative lifetime exposure to neighborhood disadvantage is understudied. Using up to five decades of residential histories for 4,177 adult participants in the Survey of Health of Wisconsin (SHOW) and spatio-temporally linked neighborhood conditions, we develop four operational approaches to characterizing cumulative neighborhood (dis)advantage over the life course. We estimated their associations with self-reported general health and compared to estimates using neighborhood (dis)advantage at time of study enrollment. When cumulative exposures were assessed with the most granular temporal scale (Approach 4), neighborhood transport constraints (OR = 1.21, 95\ 1.08, 1.36), residential turnover (OR = 1.20, 95\ 1.07, 1.34), education deficit (OR = 1.17, 95\ 1.04, 1.32), racial segregation (OR = 1.20, 95\ 1.04, 1.38) and median household income (OR = 0.85, 95\ 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\ 1.02, 1.08) than the cross-sectional exposure (OR = 1.03, 95\ 1.01, 1.06). Single point-in-time neighborhood measures underestimate the neighborhood and health relationship, underscoring the importance of a life course approach to cumulative exposure measurement.
AB - Deleterious neighborhood conditions are associated with poor health, yet the health impact of cumulative lifetime exposure to neighborhood disadvantage is understudied. Using up to five decades of residential histories for 4,177 adult participants in the Survey of Health of Wisconsin (SHOW) and spatio-temporally linked neighborhood conditions, we develop four operational approaches to characterizing cumulative neighborhood (dis)advantage over the life course. We estimated their associations with self-reported general health and compared to estimates using neighborhood (dis)advantage at time of study enrollment. When cumulative exposures were assessed with the most granular temporal scale (Approach 4), neighborhood transport constraints (OR = 1.21, 95\ 1.08, 1.36), residential turnover (OR = 1.20, 95\ 1.07, 1.34), education deficit (OR = 1.17, 95\ 1.04, 1.32), racial segregation (OR = 1.20, 95\ 1.04, 1.38) and median household income (OR = 0.85, 95\ 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\ 1.02, 1.08) than the cross-sectional exposure (OR = 1.03, 95\ 1.01, 1.06). Single point-in-time neighborhood measures underestimate the neighborhood and health relationship, underscoring the importance of a life course approach to cumulative exposure measurement.
KW - life course
KW - health
KW - residential history
KW - neighborhoods
U2 - 10.1093/aje/kwae183
DO - 10.1093/aje/kwae183
M3 - Article
C2 - 38973742
SN - 0002-9262
JO - American Journal of Epidemiology
JF - American Journal of Epidemiology
M1 - kwae183
ER -