The joint contribution of neighborhood poverty and social integration to mortality risk in the United States

Associations of face-to-face and non-face-to-face social isolation with all-cause and cause-specific mortality: 13-year follow-up of the Guangzhou Biobank Cohort study

BACKGROUND

Although social isolation has been associated with a higher mortality risk, little is known about the potential different impacts of face-to-face and non-face-to-face isolation on mortality. We examined the prospective associations of four types of social isolation, including face-to-face isolation with co-inhabitants and non-co-inhabitants, non-face-to-face isolation, and club/organization isolation, with all-cause and cause-specific mortality separately.

METHODS

This prospective cohort study included 30,430 adults in Guangzhou Biobank Cohort Study (GBCS), who were recruited during 2003-2008 and followed up till Dec 2019.

RESULTS

During an average of 13.2 years of follow-up, 4933 deaths occurred during 396,466 person-years. Participants who lived alone had higher risks of all-cause (adjusted hazard ratio (AHR) 1.24; 95% confidence interval (CI) 1.04-1.49) and cardiovascular disease (CVD) (1.61; 1.20-2.03) mortality than those who had ≥ 3 co-habitant contact after adjustment for thirteen potential confounders. Compared with those who had ≥ 1 time/month non-co-inhabitant contact, those without such contact had higher risks of all-cause (1.60; 1.20-2.00) and CVD (1.91; 1.20-2.62) mortality. The corresponding AHR (95% CI) in participants without telephone/mail contact were 1.27 (1.14-1.42) for all-cause, 1.30 (1.08-1.56) for CVD, and 1.37 (1.12-1.67) for other-cause mortality. However, no association of club/organization contact with the above mortality and no association of all four types of isolation with cancer mortality were found.

CONCLUSIONS

In this cohort study, face-to-face and non-face-to-face isolation were both positively associated with all-cause, CVD-, and other-cause (but not cancer) mortality. Our finding suggests a need to promote non-face-to-face contact among middle-aged and older adults.

Hispanic Ethnic Density May Be Protective for Older Black/African American and Non-Hispanic White Populations for Some Health Conditions: An Exploration of Support and Neighborhood Mechanisms

BACKGROUND AND PURPOSE

Hispanic ethnic density (HED) is associated with salubrious health outcomes for Hispanics, yet recent research suggests it may also be protective for other groups. The purpose of this study was to test whether HED was protective for other racial-ethnic groups. We tested whether social support or neighborhood social integration mediated the association between high HED and depressive symptoms (CES-D) and physical morbidity 5 years later. Lastly, we tested whether race-ethnicity moderated both main and indirect effects.

METHODS

We used Waves 1 (2005-2006), and 2 (2010-2011) from The National Social Life, Health, and Aging Project, a national study of older U.S. adults. Our sample was restricted to Wave 1 adults who returned at Wave 2, did not move from their residence between waves, and self-identified as Hispanic, non-Hispanic White (NHW), or non-Hispanic Black (NHB; n = 1,635). We geo-coded respondents' addresses to a census-tract and overlaid racial-ethnic population data. Moderated-mediation models using multiple imputation (to handle missingness) and bootstrapping were used to estimate indirect effects for all racial-ethnic categories.

RESULTS

Depressive symptoms were lower amongst racial-ethnic minorities in ethnically (Hispanic) dense neighborhoods; this effect was not stronger in Hispanics. HED was not associated with physical morbidity. Sensitivity analyses revealed that HED was protective for cardiovascular events in all racial-ethnic groups, but not arthritis, or respiratory disease. Social support and neighborhood social integration were not mediators for the association between HED and outcomes, nor were indirect effects moderated by race-ethnicity.

CONCLUSIONS

This study offers some evidence that HED may be protective for some conditions in older adults; however, the phenomena underlying these effects remains a question for future work.

Family-Focused Public Health: Supporting Homes and Families in Policy and Practice

Life expectancy in the US is on the decline. Mental health issues associated with opioid abuse and suicide have been implicated for this decline necessitating new approaches and procedures. While Public Health 3.0 provides a call to action for stakeholders to work closely together to address such complex problems as these, less attention has been given to engaging and supporting the most important stakeholders and primary producers of health within the US: families and households. The idea that health begins at home is discussed from the perspective of primary, secondary, and tertiary prevention levels. Primary prevention where research provides evidence for the role of the family in healthy child development. Secondary and tertiary prevention where research offers evidence for the role of the family in caregiving. Despite this evidence, greater focus and attention must be placed on the family at all prevention levels as an often overlooked setting of public health practice and level of influence. Prevention across all levels is enhanced as public health practitioners think family when designing and implementing public health policy. Four family impact principles are presented to help guide planning and implementation decisions to nourish family engagement.

How poverty affects diet to shape the microbiota and chronic disease

Here, we discuss the link between nutrition, non-communicable chronic diseases and socio-economic standing, with a special focus on the microbiota. We provide a theoretical framework and several lines of evidence from both animal and human studies that support the idea that income inequality is an underlying factor for the maladaptive changes seen in the microbiota in certain populations. We propose that this contributes to the health disparities that are seen between lower-income and higher-income populations in high-income countries.

People, Places, Power: Medicaid Concentration and Local Political Participation

The geographic concentration of disadvantage is a key mechanism of inequity. In the United States, the spatial patterning of disadvantage renders it more than the sum of its individual parts and disproportionately harms economically and racially marginalized Americans. This article focuses specifically on the political effects of Medicaid beneficiaries being concentrated in particular locales. After offering a framework for conceptualizing the community-wide consequences of such policy concentration, I analyze aggregate multiyear data to examine the effect of Medicaid density on county-level voter turnout and local organizational strength. I find that, as the proportion of county residents enrolled in Medicaid increases, the prevalence of civic and political membership associations declines and aggregate rates of voting decrease. These results suggest that, if grassroots political action is to be part of a strategy to achieve health equity, policy makers and local organizations must make efforts to counteract the sometimes demobilizing "place-based" political effects of "people-based" policies such as Medicaid.

A Cumulative Deficit Laboratory Test-based Frailty Index: Personal and Neighborhood Associations

OBJECTIVES

To explore the association between a newly developed cumulative laboratory-based frailty index (FI) and intrinsic (personal) and extrinsic (social, environmental) characteristics.

DESIGN

Cross-sectional longitudinal study.

SETTING

The third and fourth waves of the community-representative, five-county, 10-year Duke Established Populations for Epidemiologic Studies of the Elderly study, carried out in a health service-rich area.

PARTICIPANTS

Cognitively intact survivors of the third wave (N = 1,740), who provided blood samples for standard laboratory work.

MEASUREMENTS

Biomarkers (n = 28) were measured to develop a cumulative deficit laboratory test-based FI (Duke FI) derived from standard laboratory tests: SMAC-24 chemistry panel, high-density lipoprotein cholesterol panel, and complete blood count. Information was gathered on scales assessing intrinsic characteristics (personal locus of control, life satisfaction, self-esteem, depressive symptomatology) and extrinsic characteristics (support received from and provided to family and friends, stressful life events, neighborhood disadvantage).

RESULTS

The newly developed Duke FI had content, construct, concurrent, and predictive validity. In addition to sex, race, and income, the Duke FI was associated at the intrinsic level with locus of control, self-esteem, life satisfaction, and depressive symptomatology (each P < .01) and at the extrinsic level with provision (P < .01) and with receipt of instrumental help (P < .10), social stressors (P < .03), and neighborhood disadvantage (P < .01) in unadjusted analysis; race fully explained neighborhood disadvantage.

CONCLUSION

Intrinsic (personality) characteristics and personally close extrinsic characteristics (contacts with family and friends, personal stressors) are associated with laboratory test-based frailty, as is neighborhood disadvantage, although in this accessible, health service-rich environment, race fully explained association with neighborhood disadvantage, suggesting that interventions to reduce frailty in residents in such an environment should pay particular attention to characteristics that immediately affect the individual.

The social income inequality, social integration and health status of internal migrants in China

Background

To examine the interaction between social income inequality, social integration, and health status among internal migrants (IMs) who migrate between regions in China.

Methods

We used the data from the 2014 Internal Migrant Dynamic Monitoring Survey in China, which sampled 15,999 IMs in eight cities in China. The Gini coefficient at the city level was calculated to measure social income inequality and was categorized into low (0.2 < Gini <= 0.3), medium (0.3 < Gini <= 0.4), high (0.4 < x < = 0.5), and very high (Gini >0.5). Health status was measured based upon self-reported health, subjective well-being, and perceptions of stress and mental health. Social integration was measured from four perspectives (acculturation and integration willingness, social insurance, economy, social communication). Linear mixed models were used to examine the interaction effects between health statuses, social integration, and the Gini coefficient.

Results

Factors of social integration, such as economic integration and acculturation and integration willingness, were significantly related to health. Social income inequality had a negative relationship with the health status of IMs. For example, IMs in one city, Qingdao, with a medium income inequality level (Gini = 0.329), had the best health statuses and better social integration. On the other hand, IMs in another city, Shenzhen, who had a large income inequality (Gini = 0.447) were worst in health statues and had worse social integration.

Conclusion

Policies or programs targeting IMs should support integration willingness, promote a sense of belonging, and improve economic equality. In the meantime, social activities to facilitate employment and create social trust should also be promoted. At the societal level, structural and policy changes are necessary to promote income equity to promote IMs’ general health status.

The Relationship between Social Support and Diet Quality in Middle-Aged and Older Adults in the United States

BACKGROUND

Social support has been associated with physical and mental health; however, the relationship between social support and diet quality is not well understood.

OBJECTIVE

The purpose of this research was to assess the relationship between social support and overall diet quality among US adults.

DESIGN/PARTICIPANTS

This study was a secondary analysis of data from adults aged 40 years and older who participated in the cross-sectional 2007-2008 National Health and Nutrition Examination Survey (N=3,243).

MAIN OUTCOME MEASURES

Social support was determined by a modification of the Rees Social Support Index (SSI), which is the sum of five dichotomized variables addressing emotional support, financial support, marital status, close friends, and religious service attendance. Overall diet quality was measured by the Healthy Eating Index-2010 (HEI-2010) and calculated from the mean of two 24-hour dietary recalls.

STATISTICAL ANALYSES PERFORMED

SAS survey procedures were used to incorporate the appropriate sample design weights. Unweighted frequencies are reported along with weighted means and standard errors (SE). Multivariable linear regression was used to compare the total HEI-2010 scores among the six SSI groups with additional models controlling for sex, age, race/ethnicity, income level, and education level, and stratifying by sex.

RESULTS

In an unadjusted model, the mean total HEI-2010 score for those with an SSI score of 0 (n=37) was 50.0 (SE=2.83) compared to 57.1 (SE=0.89) for those with SSI score of 5 (n=676) (P<0.0001). The results were no longer statistically significant when adjusted for age, sex, race/ethnicity, income, and education level (P=0.14). However, when stratified by sex and adjusted for other demographics, higher SSI scores were associated with higher HEI-2010 scores compared to lower SSI scores in men (P=0.02), but there was no significant difference among SSI scores and HEI-2010 scores in women (P=0.43).

CONCLUSIONS

This study suggests a positive relationship between social support and overall diet quality among middle-aged and older men, but not women, in the United States.

Relationships between social isolation, neighborhood poverty, and cancer mortality in a population-based study of US adults

BACKGROUND

Social isolation is an important determinant of all-cause mortality, with evidence suggesting an association with cancer-specific mortality as well. In this study, we examined the associations between social isolation and neighborhood poverty (independently and jointly) on cancer mortality in a population-based sample of US adults.

METHODS

Using data from the Third National Health and Nutrition Examination Survey (NHANES III; 1988-1994), NHANES III Linked Mortality File (through 2011) and 1990 Census, we estimated the relationship between social isolation and high neighborhood poverty and time-to-cancer death using multivariable-adjusted Cox proportional hazards models. We examined the associations of each factor independently and explored the multiplicative and additive interaction effects on cancer mortality risk and also analyzed these associations by sex.

RESULTS

Among 16 044 US adults with 17-23 years of follow-up, there were 1133 cancer deaths. Social isolation (HR 1.25, 95% CI: 1.01-1.54) and high neighborhood poverty (HR 1.31, 95% CI: 1.08-1.60) were associated with increased risk of cancer mortality adjusting for age, sex, and race/ethnicity; in sex-specific estimates this increase in risk was evident among females only (HR 1.39, 95% CI: 1.04-1.86). These associations were attenuated upon further adjustment for socioeconomic status. There was no evidence of joint effects of social isolation and high neighborhood poverty on cancer mortality overall or in the sex-stratified models.

CONCLUSIONS

These findings suggest that social isolation and higher neighborhood poverty are independently associated with increased risk of cancer mortality, although there is no evidence to support our a priori hypothesis of a joint effect.

Racial and Ethnic Variation in the Association of Social Integration with Mortality: Ten-year Prospective Population-based US Study

Substantial data link social relationships with mortality but few studies have examined whether these associations are consistent across racial and ethnic groups. The purpose of the present study was to evaluate the presence and form of the social relationship/mortality association in a representative sample of US Black (n = 4,201), non-Hispanic White (n = 20,217) and Hispanic (n = 5,097) groups. In models adjusted for age, sex, chronic disease, socioeconomic status and smoking social integration was inversely related to ten-year survival in all groups. However, among Whites the association was linear and graded whereas among Blacks the association was linear but was statistically significant only for the highest level of social integration (hazard ratio [HR] = 0.66, 95% confidence interval = 0.47-0.94). A threshold pattern was observed among Hispanics, in that lower mortality risk was found for all social integration categories above the lowest level (HRs from 0.58 to 0.52, P's < 0.01) and each of the higher social integration categories were in turn equivalent. Received social support was unrelated to mortality across all groups. Higher social integration is associated with a survival advantage for Blacks and Whites. For Hispanics, moderate and high levels of social integration were equally protective.