Racial disparities in context: a multilevel analysis of neighborhood variations in poverty and excess mortality among black populations in Massachusetts.
OBJECTIVE
We analyzed neighborhood heterogeneity in associations among mortality, race/ethnicity, and area poverty.


METHODS
We performed a multilevel statistical analysis of Massachusetts all-cause mortality data for the period 1989 through 1991 (n=142836 deaths), modeled as 79813 cells (deaths and denominators cross-tabulated by age, gender, and race/ethnicity) at level 1 nested within 5532 block groups at level 2 within 1307 census tracts (CTs) at level 3. We also characterized CTs by percentage of the population living below poverty level.


RESULTS
Neighborhood variation in mortality across CTs and block groups was not accounted for by these areas' age, gender, and racial/ethnic composition. Neighborhood variation in mortality was much greater for the Black population than for the White population, largely because of CT-level variation in poverty rates.


CONCLUSIONS
Neighborhood heterogeneity in the relationship between mortality and race/ethnicity in Massachusetts is statistically significant and is closely related to CT-level variation in poverty.
Subramanian
S V
SV
Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Ave, Kresge 7th Floor, Boston MA 02115-6096, USA. svsubram@hsph.harvard.edu
Chen
Jarvis T
JT
Rehkopf
David H
DH
Waterman
Pamela D
PD
Krieger
Nancy
N
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D019352:Censuses; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D011203:Poverty; D011204:Poverty Areas; D012111:Residence Characteristics / Q000145:classification / Q000706:statistics & numerical data*; D012307:Risk Factors; D012959:Socioeconomic Factors; D035862:Vulnerable Populations / Q000145:classification / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data