Extant observational studies generally support the existence of a link between neighborhood context and health. However, estimating the causal impact of neighborhood effects from observational data has proven to be a challenge. Omission of relevant factors may lead to overestimating the effects of neighborhoods on health while inclusion of time-varying confounders that may also be mediators (e.g., income, labor force status) may lead to underestimation. Using longitudinal data from the 1990 to 2007 years of the Panel Study of Income Dynamics, this study investigates the link between neighborhood poverty and overall mortality risk. A marginal structural modeling strategy is employed to appropriately adjust for simultaneous mediating and confounding factors. To address the issue of possible upward bias from the omission of key variables, sensitivity analysis to assess the robustness of results against unobserved confounding is conducted. We examine two continuous measures of neighborhood poverty – single-point and a running average. Both were specified as piece-wise linear splines with a knot at 20 percent. We found no evidence from the traditional naïve strategy that neighborhood context influences mortality risk. In contrast, for both the single-point and running average neighborhood poverty specifications, the marginal structural model estimates indicated a statistically significant increase in mortality risk with increasing neighborhood poverty above the 20 percent threshold. For example, below 20 percent neighborhood poverty, no association was found. However, after the 20 percent poverty threshold is reached, each 10 percentage point increase in running average neighborhood poverty was found to increase the odds for mortality by 89 percent [95% CI = 1.22, 2.91]. Sensitivity analysis indicated that estimates were moderately robust to omitted variable bias.
Extant observational studies generally support the existence of a link between neighborhood context and health (Diez Roux & Mair, 2010; Kawachi & Berkman, 2003; Pickett & Pearl, 2001; Robert, 1999; Yen & Syme, 1999). Most of the existing literature has focused on neighborhood demographic or socioeconomic characteristics, particularly neighborhood poverty and disadvantage (Meijer, Rohl, Bloomfield, & Grittner, 2012; Riva, Gauvin, & Barnett, 2007; Robert, 1999). Other research has examined the social aspects of neighborhood environments (e.g., social capital, trust, and crime) in relation to health (Sampson, Morenoff, & Gannon-Rowley, 2002). More recently, attention has been paid to the built environment, such as housing conditions, ambient air quality, and urban form (Frank, Engelke, & Schmid, 2003). The various health outcomes that have been linked to neighborhood context include, among others, mortality (Leclere, Rogers, & Peters, 1998; Sloggett & Joshi, 1998; Yen & Syme, 1999), infectious disease (Acevedo-Garcia, 2000, 2001), low birthweight (Morenoff, 2003; O'Campo, Xue, Wang, & Caughy, 1997; Roberts, 1997; Sastry & Hussey, 2003) cigarette smoking (Diez Roux, Merkin, Hannan, Jacobs, & Kiefe, 2003; Duncan, Jones, & Moon, 1999; Immo Kleinschmidt, 1995) and diet (Morland, Wing, & Roux, 2002). These associations between health and place generally remain statistically significant even after adjusting for various individual-level socioeconomic characteristics (c.f., Oreopoulos, 2003; Reijneveld & Schene, 1998; Andrew Sloggett & Joshi, 1994).
