Neighborhood Socioeconomic Status in Relation to All-cause, Cancer, and Cardiovascular Mortality in the Black Women’s Health Study

Abstract

<p><strong>Background</strong>: Neighborhood socioeconomic status (SES) is associated with adverse health outcomes, but longitudinal data among Black Americans, who tend to live in more deprived neighborhoods, is lacking. <br />Objectives: We prospectively assessed the relation of neighborhood SES to mortality in the Black Women’s Health Study.</p><p><strong>Design</strong>: A prospective cohort of 59,000 Black women was followed from 1995-2011. Participant addresses were geocoded and US Census block group was identified. Neighborhood SES was measured by a score based on US Census block group data for six indicators of income, education and<br />wealth.</p><p><strong>Main outcome measures:</strong> Deaths were identified through the National Death Index. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% CIs with control for covariates.</p><p><strong>Results</strong>: Based on 2,598 deaths during 1995-2011, lower neighborhood SES was associated with increased all-cause and cancer mortality irrespective of individual education: among those with 16 or more years of education, HRs for lowest relative to highest neighborhood SES quartile were 1.42 (95% CI 1.18-1.71) for all-cause and 1.54 (95% CI 1.14-2.07) for cancer mortality. Neighborhood SES was associated with cardiovascular mortality among lesseducated women.</p><p><strong>Conclusions</strong>: Lower neighborhood SES is associated with greater risk of mortality among Black women. The presence of the association even among women with high levels of education suggests that individual<br />SES may not overcome the unfavorable influence of neighborhood deprivation. <em>Ethn Dis</em>. 2016;26(2):157-164; doi:10.18865/<br />ed.26.2.157</p>