Neighbourhood characteristics and 10-year risk of depression in Canadian adults with and without a chronic illness

The neighbourhood environment could play a role in the risk of depression in adults and those with a chronic illness. We investigated the effects of a range of neighbourhood characteristics on the 10-year risk of depression in a representative sample of 9026 Canadian adults and subsamples with a chronic condition. Characteristics of neighbourhoods were not significantly related to the risk of depression in the general sample and subsamples with a chronic condition. However, residing near a park was significantly associated with a lower risk of depression for people living in crowded households, and having a local health service nearby was protective for those living in materially deprived neighbourhoods. Living in a neighbourhood that was both socially advantaged and offered cultural services was also associated with lower risk of depression. Additional research is needed for smaller effect size detection. Future intervention research is warranted for health policy recommendations.     

The role of individual and contextual socioeconomic circumstances on mortality: analysis of time variations in a city of north west Italy

STUDY OBJECTIVE: To evaluate the independent and mutual effects of neighbourhood deprivation and of individual socioeconomic conditions on mortality and to assess the trends over the past 30 years and the residual neighbourhood heterogeneity. DESIGN: General and cause specific mortality was analysed as a function of time period, highest educational level achieved, housing conditions, and neighbourhood deprivation, using multilevel Poisson models stratified by gender and age class. SETTING: The study was conducted in Turin, a city in north west Italy with nearly one million inhabitants and consisting of 23 neighbourhoods. PARTICIPANTS: The study population included three cohorts of persons aged 15 years or older, recorded in the censuses of 1971, 1981, and 1991 and followed up for 10 years after each census. MAIN RESULTS: Individual and contextual socioeconomic conditions showed an independent and significant impact on mortality, both among men and women, with significantly higher risks for coronary heart and respiratory diseases among people, aged less than 65 years, residing in deprived neighbourhoods (9% and 15% excess for coronary heart diseases, 20% and 24% for respiratory diseases, respectively for men and women living in deprived neighbourhoods compared with rich). The decreasing time trend in general mortality was less pronounced among men with lower education and poorer housing conditions, compared with their more advantaged counterparts; the same was found in less educated women aged less than 65 years. CONCLUSIONS: These results and further developments in the evaluation of impact and mechanisms of other contextual effects can provide information for both health and non-health oriented urban policies.     

Neighbourhood deprivation and alcohol consumption: does the availability of alcohol play a role?

BACKGROUND: Previous studies suggest that the physical availability of alcohol may mediate the association between neighbourhood-level material deprivation and alcohol consumption. This study tests the relationships between neighbourhood-level deprivation, alcohol availability, and individual-level alcohol consumption using a multilevel analysis. METHODS: Data are from cross-sectional surveys conducted between 1979 and 1990 as part of the Stanford Heart Disease Prevention Program (SHDPP). Women and men (n = 8197) living in four northern/central California cities and 82 neighbourhoods were linked to neighbourhood deprivation variables derived from the US census (e.g. unemployment, crowded housing) and to measures of alcohol availability (density of outlets in the respondent's neighbourhood, nearest distance to an outlet from the respondent's home, and number of outlets within a half mile radius of the respondent's home). Separate analyses were conducted for on- and off-sale outlets. RESULTS: The most deprived neighbourhoods had substantially higher levels of alcohol outlet density than the least deprived neighbourhoods (45.5% vs 14.8%, respectively). However, multilevel analyses showed that the least deprived neighbourhoods were associated with the heaviest alcohol consumption, even after adjusting for individual-level sociodemographic characteristics (OR 1.30, CI 1.08-1.56). Alcohol availability was not associated with heavy drinking and thus did not mediate the relationship between neighbourhood deprivation and heavy alcohol consumption. CONCLUSIONS: Although alcohol availability is concentrated in the most deprived neighbourhoods, women and men in least deprived neighbourhoods are most likely to be heavy drinkers. This mismatch between supply and demand may cause people in the most deprived neighbourhoods to disproportionately suffer the negative health consequences of living near alcohol outlets.     

Neighbourhood deprivation and health: does it affect us all equally?

BACKGROUND: Neighbourhood socioeconomic status (SES) may affect rich and poor residents differentially. Two models are proposed. Model 1: living in a non-deprived neighbourhood is better for health because better collective material and social resources are available. Model 2: being poor (rich) relative to the neighbourhood average is associated with worse (better) health because of the discrepancy between an individual's situation and those around them. METHODS: Individual data from the Whitehall II study covering health, SES, and perceived status were linked to census data on neighbourhood deprivation. RESULTS: Both individual and neighbourhood deprivation increased the risk of poor general and mental health. There was a suggestion that the effect of living in a deprived area was more marked for poorer individuals, although interactions were not statistically significant. Poor people in poor neighbourhoods reported more financial and neighbourhood problems and rated themselves lowest on the ladder of society. CONCLUSIONS: We found no evidence that personal poverty combined with affluent neighbourhood had negative health consequences. Rather, living in a deprived neighbourhood may have the most negative health effects on poorer individuals, possibly because they are more dependent on collective resources in the neighbourhood.     

Neighbourhood deprivation and incidence of coronary heart disease: a multilevel study of 2.6 million women and men in Sweden

STUDY OBJECTIVE: To examine whether neighbourhood deprivation predicts incidence rates of coronary heart disease, beyond age and individual income. DESIGN: Follow up study from 31 December 1995 to 31 December 1999. Women and men were analysed separately with respect to incidence rates of coronary heart disease. Multilevel logistic regression was used in the analysis with individual level characteristics (age, individual income) at the first level and level of neighbourhood deprivation at the second level. Neighbourhood deprivation was measured at small area market statistics level by the use of Care Need Index. SETTING: Sweden. PARTICIPANTS: All women and men aged 40-64 in the Swedish population, in total 2.6 million people. MAIN RESULTS: There was a strong relation between level of neighbourhood deprivation and incidence rates of coronary heart disease for both women and men. In the full model, which took account of individual income, the risk of developing coronary heart disease was 87% higher for women and 42% higher for men in the most deprived neighbourhoods than in the most affluent neighbourhoods. For both women and men the variance at neighbourhood level was over twice the standard error, indicating significant differences in coronary heart disease risk between neighbourhoods. CONCLUSIONS: High levels of neighbourhood deprivation independently predict coronary heart disease for both women and men. Both individual and neighbourhood level approaches are important in health care policies.     

Neighbourhood deprivation and self-rated health: the role of perceptions of the neighbourhood and of housing problems

It has been known for a long time that people living in socially and economically deprived neighbourhoods generally experience poorer health. However, it is often not clear what processes underlie the relationship between neighbourhood deprivation and individual health. In this study we explore the association between neighbourhood socio-economic status and self-rated health using the Caerphilly Health and Social Needs Survey (n=10,892). We found that the association between neighbourhood deprivation and self-rated health was substantially reduced after adjusting for individual socio-economic status, but remained statistically significant. This suggests that the health effects of neighbourhood deprivation are partly contextual. We also found that the association between neighbourhood deprivation and self-rated health was further attenuated when controlling for perceptions of the neighbourhood and of housing problems, suggesting that these variables may play a role in mediating the health effects of neighbourhood deprivation. The implications of the results are that health policy should target 'places' as well as 'people'; and that policies aimed at improving the quality of housing, access to amenities, neighbourhood safety, and social cohesion may help to reduce health inequalities.     

Household and neighbourhood risks for injury to 5-14 year old children

Injuries in childhood are strongly related to poverty at the household level and to living in a deprived neighbourhood, but it is not clear whether these effects are independent. In this prospective population study, all injuries to 5-14 year old children living in the city of Norwich, UK, and presented at the hospital Accident and Emergency Department over a 13 month period were recorded (N=3526). Information on the population of resident children and household composition was assembled from the health authority population register. Neighbourhood information was extracted from the census and local surveys. Unadjusted risks were calculated for individual and neighbourhood factors, followed by multilevel modelling in which predictors were included at three levels: individual, enumeration district and social area (neighbourhood). The overall injury rate was 16.44 per 100 children per year. Injury rates between neighbourhoods varied two-fold and were highest in more deprived areas. In the final multilevel model injury risk was related to gender (boys vs. girls OR=1.35), age of child (OR=1.07 per year), number of adults in the household (OR=0.91 per adult), and age gap between child and eldest female (15-24 years vs. 25-34 years, OR=1.15). Injury rates were also related to social area deprivation, although variations in injury rates between neighbourhoods were not wholly explained by deprivation. The adjusted odds ratio between the most and least deprived social areas was 1.35. Excluding less serious injuries did not substantially change the results. The risks were very similar to those found in a previous study of pre-school children, with the same neighbourhoods identified as high and low risk as before. This evidence that neighbourhood factors independently influence injury risk over and above individual and household factors supports the use of area-based policies to reduce injuries in children.     

Contribution of neighbourhood socioeconomic status and physical activity resources to physical activity among women

INTRODUCTION: Residence in a deprived neighbourhood is associated with lower rates of physical activity. Little is known about the manifestation of deprivation that mediates this relationship. This study aimed to investigate whether access to physical activity resources mediated the relationship between neighbourhood socioeconomic status and physical activity among women. METHOD: Individual data from women participating in the Stanford Heart Disease Prevention Program (1979-90) were linked to census and archival data from existing records. Multilevel regression models were examined for energy expenditure and moderate and vigorous physical activity as reported in physical activity recalls. RESULTS: After accounting for individual-level socioeconomic status, women who lived in lower-socioeconomic status neighbourhoods reported greater energy expenditure, but undertook less moderate physical activity, than women in moderate-socioeconomic status neighbourhoods. In contrast, women living in higher-socioeconomic status neighbourhoods reported more vigorous physical activity than women in moderate-socioeconomic status neighbourhoods. Although availability of physical activity resources did not appear to mediate any neighbourhood socioeconomic status associations, several significant interactions emerged, suggesting that women with low income or who live in lower-socioeconomic status neighbourhoods may differentially benefit from greater physical activity resource availability. DISCUSSION: Although we found expected relationships between residence in a lower-socioeconomic status neighbourhood and undertaking less moderate or vigorous physical activity among women, we also found that these same women reported greater overall energy expenditure, perhaps as a result of greater work or travel demands. Greater availability of physical activity resources nearby appears to differentially benefit women living in lower-socioeconomic status neighbourhoods and low-income women, having implications for policy-making and planning.     

Cardiovascular risk factors and the neighbourhood environment: a multilevel analysis

BACKGROUND: This article examines whether the neighbourhood environment influences intermediate cardiovascular disease (CVD) risk factors, such as obesity (body mass index [BMI]), and lifestyle factors, such as no physical activity and smoking, when adjusted for the individual socioeconomic status (SES). METHODS: The study consists of face-to-face interviews from the Swedish Annual Level of Living Survey (SALLS) matched with the social status of the respondents' residential areas measured by two composite indices, the Care Need Index (CNI) and the Townsend score. The response rate was about 80%. This study was limited to the residents aged 25-74 years and consists of 9240 interviews from the years 1988-1989, when there were extended items in the SALLS about health and lifestyle. The data were analysed using a hierarchical logistic regression model. RESULTS: There was a gradient within every SES group so that respondents with a low (or intermediate or high) educational level exhibited an increasing proportion of daily smokers, physically inactive people and obese individuals with increasing neighbourhood deprivation. The multilevel model showed that respondents living in the most deprived neighbourhoods had an increased risk for being a daily smoker, engaging in no physical activity and being obese when adjusted for the individual SES. CONCLUSIONS: We showed that the area level has an important influence on risk factors for CVD which goes beyond the individual educational attainment. An increased level of living standard, more resources for primary health care and health promotion targeting the community level should be beneficial.     

Spatial and social determinants of urban health in low-, middle- and high-income countries

Urban populations around the world face increasingly common health problems. This is partly because of common spatial and socio-economic factors that result in substantial inequalities in health among urban populations. Spatial methods can now map out dimensions of urban living, such as the segregation of poor communities as a result of population concentration of poverty in deprived neighbourhoods. Even in rich countries such as the UK, separate from the health disadvantages of living in a poor neighbourhood, if you live in a neighbourhood that is surrounded by deprivation, you have a higher risk of mortality. However, neighbourhood deprivation is not synonymous with poor social capital. Some communities can be resilient to the health-damaging aspects of living in a poor neighbourhood if they have access to social support and other social ties.     

Neighbourhood characteristics and mortality in the Atherosclerosis Risk in Communities Study

BACKGROUND: This study investigates the relationship between neighbourhood characteristics and mortality (all-cause, cardiovascular disease [CVD], and cancer) in the Atherosclerosis Risk in Communities Study (ARIC). METHODS: Analysis was limited to African-American and white participants 45-64 years of age at baseline whose records were linked to census data. Deaths ascertained through 31 December 1999 were included in the analysis. Individual-level characteristics were obtained from the baseline interview. A composite index was used to characterize the neighbourhood socioeconomic environment. Proportional hazards regression was used to estimate the effect of neighbourhood socioeconomic status (SES) index and family income on the survival time. RESULTS: The rate of mortality adjusted for age and gender was highest among those who lived in disadvantaged neighbourhoods and were of lower SES. In general, all-cause and CVD mortality rates decreased with increasing neighbourhood SES advantage and family income in all race-gender groups. Although this pattern generally persisted after adjustment for individual socioeconomic factors, statistically significant associations persisted for CVD mortality in whites only (hazard ratio = 1.4, 95% CI: 1.0, 2.0) for most disadvantaged versus most advantaged tertile). When compared with the most affluent participants living in the most advantaged neighbourhoods, the increased risk of all-cause and CVD mortality associated with being poor and living in the most disadvantaged neighbourhoods was equivalent to being 11 and 13 years older at baseline for whites and African Americans, respectively. CONCLUSION: Our findings indicate that neighbourhood socioeconomic characteristics are associated with modest increases in CVD mortality in white adults. The lack of neighbourhood effects in African Americans needs to be interpreted with caution due to the limited range in the characteristics of the neighbourhood from which these participants were drawn.     

Neighbourhood deprivation and the cost of accessing gyms and fitness centres: National study in Wales

It has been hypothesised that residents of deprived neighbourhoods have poorer economic access to physical activity resources, inhibiting physical activity. Here we explore whether the cost of accessing gyms and fitness centres varies by neighbourhood deprivation in Wales. The location of gyms and fitness suites were obtained, and a telephone survey of all facilities was conducted to collect entry price data. We tested associations between neighbourhood deprivation and mean entry prices for public and private facilities. The cost of accessing private facilities is lower in deprived versus affluent neighbourhoods, whereas costs are similar across all deprivation categories for public facilities.     

Urban built environment and depression: a multilevel analysis

STUDY OBJECTIVE: To assess the relations between characteristics of the neighbourhood internal and external built environment and past six month and lifetime depression. DESIGN AND SETTING: Depression and sociodemographic information were assessed in a cross sectional survey of residents of New York City (NYC). All respondents were geocoded to neighbourhood of residence. Data on the quality of the built environment in 59 NYC neighbourhoods were collected from the United Status census, the New York City housing and vacancy survey, and the fiscal 2002 New York City mayor's management report. MAIN RESULTS: Among 1355 respondents, residence in neighbourhoods characterised by a poor quality built environment was associated with greater individual likelihood of past six month and lifetime depression in multilevel models adjusting for individual age, race/ethnicity, sex, and income and for neighbourhood level income. In adjusted models, persons living in neighbourhoods characterised by poorer features of the built environment were 29%-58% more likely to report past six month depression and 36%-64% more likely to report lifetime depression than respondents living in neighbourhoods characterised by better features of the built environment. CONCLUSIONS: Living in neighbourhoods characterised by a poor quality built environment is associated with a greater likelihood of depression. Future prospective work designed to assess potential mechanisms underlying these associations may guide public health and urban planning efforts aimed at improving population mental health.     

An investigation of the longitudinal relationship between neighbourhood income inequality and individual self-rated health in England

There are mixed findings on whether neighbourhood income inequality leads to better self-rated health (SRH) or not. This study considers two hypotheses: individuals living in more unequal neighbourhoods have better SRH and the level of neighbourhood income inequality and its impact on SRH is moderated by household and neighbourhood level income related variables. Data from Waves 8–10 of the UK Household Longitudinal Study for respondents living in England at wave 8 were used. Neighbourhood income inequality was measured using Gini coefficients of household income from the Pay As You Earn and benefits systems for Lower Super Output Areas. Longitudinal ordinal multilevel models predicted self-rated health in 2016–18, 2017–19 and 2019-20 by income inequality and its interaction with household income, neighbourhood median income and neighbourhood deprivation, conditional on individual educational attainment, age, sex, ethnic group, years lived in current residence, region of residence and study wave. There were 24,889 respondents analysed over three waves. SRH was worse for those living in more income equal neighbourhoods. There was no indication that neighbourhood inequality was moderated by household income, neighbourhood median income or neighbourhood deprivation. These findings are in line with the balance of existing evidence and support policy interventions that aim to create mixed communities for the purpose of improving population health.     

The potential for walkability to narrow neighbourhood socioeconomic inequalities in physical function: A case study of middle-aged to older adults in Brisbane,Australia

Residents of disadvantaged neighbourhoods have poorer physical function than their advantaged counterparts, although the reasons for this remain largely unknown. We examined the moderating effects of walkability in the relationship between neighbourhood disadvantage and physical function using 2013 cross-sectional data from 5115 individuals aged 46–72 living in 200 neighbourhoods in Brisbane, Australia. The relationship between neighbourhood disadvantage and physical function differed by levels of walkability: positive associations as levels of walkability increased for those living in more disadvantaged neighbourhoods, and no difference for those living in more advantaged neighbourhoods. Further work is required to better understand the underlying mechanisms.     

Deprived yet healthy: Neighbourhood-level resilience in New Zealand

Geographical inequalities in health are omnipresent with health and related behaviours typically worse in socioeconomically deprived places. However, this is not always true. Deprived places with unexpectedly good health outcomes, or what might be considered ‘resilient’ places, have been noted. Few studies have quantitatively examined resilience in neighbourhoods or investigated potential explanations for this resilience. This paper examines the paradox of low mortality despite high social deprivation in New Zealand neighbourhoods and considers possible neighbourhood characteristics that contribute to unanticipated positive health outcomes. Using area-level mortality (2005–2007) and socioeconomic data, we developed the Resilience Index New Zealand to quantify neighbourhood levels of resilience across the country. We then examined relationships between this measure and a suite of built, physical and social characteristics. We found that resilient places tended to be densely populated, urban areas. We observed gradients and increases/decreases in the most resilient groups in access to or levels of physical environment factors (environmental deprivation, safe drinking water, air quality) and unhealthy living infrastructure (alcohol and gambling outlets). Since these factors are amenable to change, these findings are the strongest evidence that such improvements may lower mortality in similarly deprived places. The social environment of resilient areas was characterised by high levels of incoming residents. We also found some surprising associations and observed U-shaped relationships for a number of the neighbourhood factors. Such findings suggest the need to develop a better proxy of community cohesion and a better understanding of the interactions between people and their neighbourhoods, rather than simply the presence of certain factors. We argue that this study has identified amenable neighbourhood characteristics and highlighted the importance of ‘place-specific’ resilience factors that may be effective in reducing mortality in some neighbourhoods, but be less effective in others.     

‘Faking til you make it’: Social capital accumulation of individuals on low incomes living in contrasting socio-economic neighbourhoods and its implications for health and wellbeing

People on low-income living in low socio-economic neighbourhoods have poorer health in comparison with those living in advantaged neighbourhoods. To explore neighbourhood effects on health and social capital creation, the experiences of low-income people living in contrasting socio-economic neighbourhoods were compared, in order to examine how low-income status and differing levels of neighbourhood resources contributed to perceived health and wellbeing. Quantitative and qualitative data were analysed: survey data from 601 individuals living in contrasting socio-economic areas and in-depth interviews with a new sample of 24 individuals on low-incomes. The study was guided by Bourdieu's theory of practice, which examines how social inequalities are created and reproduced through the relationship between individuals' varying resources of economic, social and cultural capital. This included an examination of individual life histories, cultural distinction and how social positions are reproduced. Participants' accounts of their early life experience showed how parental socio-economic position and socially patterned events taking place across the life course, created different opportunities for social network creation, choice of neighbourhood and levels of resources available throughout life, all of which can influence health and wellbeing. A definition of poverty by whether an individual or household has sufficient income at a particular point in time was an inadequate measure of disadvantage. This static measure of ‘low income’ as a category disguised a number of different ways in which disadvantage was experienced or, conversely, how life course events could mitigate the impact of low-income. This study found that the resources necessary to create social capital such as cultural capital and the ability to socially network, differed according to the socio-economic status of the neighbourhood, and that living in an advantaged area does not automatically guarantee access to potentially beneficial social networks.     

Double burden of deprivation and high concentrations of ambient air pollution at the neighbourhood scale in Montreal, Canada

Some neighbourhoods in urban areas are characterised by concentrations of socially and materially deprived populations. Additionally, levels of ambient air pollution in a city can be variable at the local scale and can create disparities in air quality between neighbourhoods. Socioeconomic and physical characteristics of neighbourhood environments can affect the health and well-being of local residents. In this paper we identify whether neighbourhoods in Montreal, Canada characterised by social and material deprivation have higher levels of ambient air pollution than do others.We collected two-week integrated samples of nitrogen dioxide (NO₂) at 133 sites in Montreal during three seasons between 2005 and 2006. We used these data in a geographic information system, along with data describing characteristics of land use, roads, and traffic, to create a spatial model of predicted mean annual concentrations of NO₂ across Montreal. Next, we collected neighbourhood socioeconomic information for 501 census tracts and overlaid their boundaries on the pollution surface. We calculated Pearson correlation coefficients and 95% confidence intervals (CI) between neighbourhood-level indicators of deprivation and levels of ambient NO₂.We found associations between concentrations of NO₂ and neighbourhood-level indicators of material deprivation, including median household income, and with indicators of social deprivation, including proportion of people living alone. We identified specific neighbourhoods that were characterised by a double burden of high levels of deprivation and high concentrations of ambient NO₂. Because of the particular social geography in Montreal, we found that not all deprived neighbourhoods had high levels of pollution and that some affluent neighbourhoods in the downtown core had high levels. Our results underscore the importance of considering social contexts in interpreting general associations between social and environmental risks to population health.     

Deprivation indicators as predictors of life events 1981-1992 based on the UK ONS Longitudinal Study

STUDY OBJECTIVE: To investigate the association between the level of social deprivation in electoral wards and various life events. Life events include mortality, self reported long term illness, and for women: still-birth, underweight birth, birth while a teenager, and sole registered birth. Associations with area deprivation are tested before and after allowing for levels of personal deprivation. DESIGN: Prospective census follow up using the Office for National Statistics Longitudinal Study. SETTING: England and Wales. PARTICIPANTS: A random sample of more than 300,000 people enumerated at the 1981 census, and aged 10 to 64 in 1981. Some analyses are necessarily restricted to certain age/sex groups. OUTCOME MEASURES: Several outcomes in the decade 1981-1992 are investigated: risk of premature death (before age 70, all cause), risk of long term limiting illness in 1991, and risk of inauspicious fertility outcomes in women. MAIN RESULTS: Without adjusting for personal circumstances all outcomes, except risk of stillbirth, show a clear, significant, and approximately linear association with social deprivation of ward of residence in 1981. Associations are much stronger for outcomes where a greater "social" component can be constructed (teenage birth, sole registered birth) than for outcomes that are probably more physiologically determined (mortality, stillbirth, low birth weight). When adjustment is made for personal disadvantage the simple associations with local area deprivation are all attenuated, especially for those living in the more deprived areas. CONCLUSIONS: A variety of adverse or "inauspicious" life events show association with residence in more deprived areas. These are particularly strong for teenage birth and sole registered birth, but are also stronger for long term illness than mortality. These associations seem to be largely because residence in more deprived areas is associated with personal disadvantage, which is more damaging to life chances than area of residence. For some outcomes there is evidence that the personally disadvantaged fare less well if living in relatively advantaged areas, than if living in more homogenously deprived areas.