The health implications of cumulative exposure to contextual (dis)advantage: Methodological and substantive advances from a unique data linkage

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.