Socioeconomic status and injury mortality: individual and neighbourhood determinants.
OBJECTIVE
This study examined both individual and neighbourhood correlates of injury mortality to better understand the contribution of socioeconomic status to cause specific injury mortality. Of particular interest was whether neighbourhood effects remained after adjusting for individual demographic characteristics and socioeconomic status.


METHODS
Census tract data (measuring small area socioeconomic status, racial concentration, residential stability, urbanisation, and family structure) was merged with the National Health Interview Survey (NHIS) and a file that links the respondents to subsequent follow up of vital status and cause of death data. Cox proportional hazards models were specified to determine individual and neighbourhood effects on homicide, suicide, motor vehicle deaths, and other external causes. Variances are adjusted for the clustered sample design of the NHIS.


METHODS
United States, 1987-1994, with follow up to the end of 1995.


METHODS
From a sample of 472 364 persons ages 18-64, there were 1195 injury related deaths over the follow up period.


RESULTS
Individual level effects were generally robust to the inclusion of neighbourhood level variables in the models. Neighbourhood characteristics had independent effects on the outcome even after adjustment for individual variability. For example, there was approximately a twofold increased risk of homicide associated with living in a neighborhood characterised by low socioeconomic status, after adjusting for individual demographic and socioeconomic characteristics.


CONCLUSIONS
Social inequalities in injury mortality exist for both persons and places. Policies or interventions aimed at preventing or controlling injuries should take into account not only the socioeconomic characteristics of people but also of the places in which they live.
Cubbin
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Stanford Center for Research in Disease Prevention, Stanford University School of Medicine, 1000 Welch Road, Palo Alto, CA 94304-1825, USA. ccubbin@leland.stanford.edu
LeClere
F B
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Smith
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D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D003627:Data Interpretation, Statistical; D005260:Female; D006708:Homicide / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012111:Residence Characteristics; D012923:Social Class; D013405:Suicide / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality*