title: Perceived neighborhood safety and incident mobility disability among elders: the hazards of poverty.
abstract: BACKGROUND
  We investigated whether lack of perceived neighborhood safety due to crime, or living in high crime neighborhoods was associated with incident mobility disability in elderly populations. We hypothesized that low-income elders and elders at retirement age (65 - 74) would be at greatest risk of mobility disability onset in the face of perceived or measured crime-related safety hazards.
  
  
  METHODS
  We conducted the study in the New Haven Established Populations for Epidemiologic Studies of the Elderly (EPESE), a longitudinal cohort study of community-dwelling elders aged 65 and older who were residents of New Haven, Connecticut in 1982. Elders were interviewed beginning in 1982 to assess mobility (ability to climb stairs and walk a half mile), perceptions of their neighborhood safety due to crime, annual household income, lifestyle characteristics (smoking, alcohol use, physical activity), and the presence of chronic co-morbid conditions. Additionally, we collected baseline data on neighborhood crime events from the New Haven Register newspaper in 1982 to measure local area crime rates at the census tract level.
  
  
  RESULTS
  At baseline in 1982, 1,884 elders were without mobility disability. After 8 years of follow-up, perceiving safety hazards was associated with increased risk of mobility disability among elders at retirement age whose incomes were below the federal poverty line (HR 1.56, 95% CI 1.02 - 2.37). No effect of perceived safety hazards was found among elders at retirement age whose incomes were above the poverty line. No effect of living in neighborhoods with high crime rates (measured by newspaper reports) was found in any sub-group.
  
  
  CONCLUSIONS
  Perceiving a safety hazard due to neighborhood crime was associated with increased risk of incident mobility disability among impoverished elders near retirement age. Consistent with prior literature, retirement age appears to be a vulnerable period with respect to the effect of neighborhood conditions on elder health. Community violence prevention activities should address perceived safety among vulnerable populations, such as low-income elders at retirement age, to reduce future risks of mobility disability.
authors.affiliation: Center for Community Health and Health Equity, Division of General Medicine and Primary Care, Brigham and Women's Faulkner Hospitalist Program, Brigham and Women's Hospital, Boston, Massachusetts, USA. crclark@partners.org
authors.forename: Cheryl R
authors.initials: CR
authors.lastname: Clark
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
authors.forename: Louise
authors.initials: L
authors.lastname: Ryan
authors.forename: Karen
authors.initials: K
authors.lastname: Ertel
authors.forename: Martha E
authors.initials: ME
authors.lastname: Fay
authors.forename: Lisa F
authors.initials: LF
authors.lastname: Berkman
mesh_terms: D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D003237:Connecticut; D003415:Crime; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D051346:Mobility Limitation; D010465:Perception; D011203:Poverty; D012111:Residence Characteristics; D012307:Risk Factors; D012449:Safety; D016138:Walking