Monday, October 17, 2022

Association of Neighborhood Conditions and Resources for Children With Life Expectancy at Birth in the US

Key Points

Question  Are neighborhood conditions and resources for children associated with life expectancy at birth in the US?

Findings  In this cross-sectional study of residents from 65 662 US Census tracts, neighborhood conditions and resources for children explained substantial variability in life expectancy at birth. Neighborhood conditions and resources for children had a stepwise association with life expectancy at birth, with the lowest life expectancy in the communities with the lowest neighborhood conditions and resources for children.

Meaning  The study’s findings suggest that neighborhood conditions and resources for children are potentially important targets for health policy aimed at improving life expectancy for socially vulnerable populations in the US.

Abstract

Importance  To address inequities in life expectancy, we must understand the associations of modifiable socioeconomic and structural factors with life expectancy. However, the association of limited neighborhood resources and deleterious physical conditions with life expectancy is not well understood.

Objective  To evaluate the association of community social and economic conditions and resources for children with life expectancy at birth.

Design, Setting, and Participants  This cross-sectional study examined neighborhood child opportunity and life expectancy using data from residents of 65 662 US Census tracts in 2015. The analysis was conducted from July 6 to October 1, 2021.

Exposures  Neighborhood conditions and resources for children in 2015.

Main Outcomes and Measures  The primary outcome was life expectancy at birth at the Census tract level based on data from the US Small-Area Life Expectancy Estimates Project (January 1, 2010, to December 31, 2015). Neighborhood conditions and resources for children were quantified by Census tract Child Opportunity Index (COI) 2.0 scores for 2015. This index captures community conditions associated with children’s health and long-term outcomes categorized into 5 levels, from very low to very high opportunity. It includes 29 indicators in 3 domains: education, health and environment, and social and economic factors. Mixed-effects and simple linear regression models were used to estimate the associations between standardized COI scores (composite and domain-specific) and life expectancy.

Results  The study included residents from 65 662 of 73 057 US Census tracts (89.9%). Life expectancy at birth across Census tracts ranged from 56.3 years to 93.6 years (mean [SD], 78.2 [4.0] years). Life expectancy in Census tracts with very low COI scores was lower than life expectancy in Census tracts with very high COI scores (−7.06 years [95% CI, −7.13 to −6.99 years]). Stepwise associations were observed between COI scores and life expectancy. For each domain, life expectancy was shortest in Census tracts with very low compared with very high COI scores (education: β = −2.02 years [95% CI, −2.12 to −1.92 years]); health and environment: β = −2.30 years [95% CI, −2.41 to −2.20 years]; social and economic: β = −4.16 years [95% CI, −4.26 to −4.06 years]). The models accounted for 41% to 54% of variability in life expectancy at birth (R2 = 0.41-0.54).

Conclusions and Relevance  In this study, neighborhood conditions and resources for children were significantly associated with life expectancy at birth, accounting for substantial variability in life expectancy at the Census tract level. These findings suggest that community resources and conditions are important targets for antipoverty interventions and policies to improve life expectancy and address health inequities.

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Association of Neighborhood Conditions and Resources for Children With Life Expectancy at Birth in the US | Health Disparities | JAMA Network Open | JAMA Network

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