Neighborhood effects on posthospitalization mortality: a population-based cohort study of the elderly in Chicago.
BACKGROUND
Place of residence is associated with health outcomes.


OBJECTIVE
To examine neighborhood effects on mortality after the onset of serious disease and to assess whether these effects vary for different sociodemographic or diagnostic subgroups.


METHODS
Our sample consists of a complete cohort of 10,557 elderly Medicare beneficiaries throughout the city of Chicago newly diagnosed and hospitalized for the first time with one of five common serious diseases in 1993 (stroke, myocardial infarction, congestive heart failure, hip fracture, and lung cancer) followed until 1999. Attributes of 51 zip code neighborhoods were obtained both from census data (1990) and from a comprehensive social survey of neighborhood residents (1994-1995). Cox proportional hazards models with robust standard errors were specified.


METHODS
Survival after hospitalization.


RESULTS
People who lived in neighborhoods with higher socioeconomic status (SES) or with a better social environment had significantly longer survival after disease onset. We evaluated the differential impact of neighborhood attributes on survival depending on gender, race, and poverty using interaction terms. Only the interaction terms between neighborhood social-structural factors and individual poverty were significant, suggesting that neighborhood SES and social environment were especially helpful for people with higher income. Neighborhood attributes did not differ in their impact depending on the race or sex of the subjects. Analyses of cause-specific mortality showed that myocardial infarction was the primary force driving the associations between neighborhood attributes and mortality.


CONCLUSIONS
Where people live matters with respect to posthospitalization mortality, but how neighborhoods affect this outcome depends on individual demographic and diagnostic characteristics. Myocardial infarction in particular may be a "neighborhood sensitive" condition. Individuals' health may depend not just on individuals' characteristics but also on their neighborhoods'.
Wen
Ming
M
Department of Sociology, University of Utah, Salt Lake City, UT 84112, USA.
Christakis
Nicholas A
NA
D000368:Aged; D002641:Chicago / Q000453:epidemiology; D015331:Cohort Studies; D003953:Diagnosis-Related Groups; D005163:Factor Analysis, Statistical; D005260:Female; D006760:Hospitalization; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D006278:Medicare; D009026:Mortality; D009203:Myocardial Infarction / Q000401:mortality; D011203:Poverty; D016016:Proportional Hazards Models; D012111:Residence Characteristics; D012931:Social Environment; D012944:Social Support; D012959:Socioeconomic Factors; D015996:Survival Rate