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

Abstract

Background 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. Objective 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. Research design and subjects A retrospective study of 362,609 Medicare Advantage respondents to the 2014–2015 Medicare Health Outcomes Survey aged 65 and older. Measures 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. 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<0.001) or homeowning individuals (4.73% in the least disadvantaged neighborhood; 6.25% in the most disadvantaged neighborhood; difference p-value<0.001). However, this study did not observe a significant difference in predicted mortality rates among low-income individuals by neighborhood (8.7% in the least disadvantaged neighborhood; 8.61% in the most disadvantaged neighborhood; difference p-value = 0.825). Conclusions Low-income or non-homeowning older adults had a higher risk of mortality regardless of neighborhood socioeconomic status. While living in a less disadvantaged neighborhood provided a protective association for higher-income or homeowning older adults, low-income older adults did not experience an observable benefit.