Is Living in a Poor Neighborhood Associated with Higher Mortality Rates?

The study investigates whether lower neighborhood socioeconomic status (SES) throughout life is associated with premature mortality. Using data from 12,610 participants in the Atherosclerosis Risk in Communities (ARIC) study, the researchers analyzed SES scores derived from census data linked to participants’ addresses during childhood, young adulthood, and middle adulthood. Findings indicate that low SES in middle adulthood significantly increases premature mortality risk (HR, 1.28; 95% CI, 1.07-1.54). Low SES during young adulthood also elevates risk among women (HR, 1.25; 95% CI, 1.00-1.56). Persistently low SES from young to middle adulthood correlates with the greatest mortality risk (HR, 1.25; 95% CI, 1.05-1.49)​.

Full Citation

Lawrence, W. R., Kucharska-Newton, A. M., Magnani, J. W., Brewer, L. C., Shiels, M. S., George, K. M., Lutsey, P. L., Jenkins, B. D., Sullivan, K. J., Carson, A. P., & Freedman, N. D. (2024). Neighborhood Socioeconomic Disadvantage Across the Life Course and Premature Mortality. JAMA Network Open, 7(8),

e2426243. https://doi.org/10.1001/jamanetworkopen.2024.26243.

Here is the link to the article on the publisher's website​.

Full Summary

1. Central Research Question

The study aims to answer whether lower neighborhood socioeconomic status (SES) experienced throughout various life stages (childhood, young adulthood, and middle adulthood) is associated with an increased risk of premature mortality. Specifically, the research explores the impact of low SES at different life epochs and evaluates whether persistently low SES from young to middle adulthood correlates with heightened mortality risk before age 75.

2. Previous Literature

Previous studies have consistently demonstrated a relationship between low SES and increased risk of chronic diseases and premature death. However, much of this research has focused on SES measured during a single time point, typically in middle to older adulthood, without accounting for early-life neighborhood conditions. Studies suggest that the socioeconomic environment influences health outcomes by affecting access to resources such as healthcare, quality housing, fresh food, and safe spaces for physical activity. Limited studies have examined the cumulative impact of neighborhood SES across life stages on mortality risk. The current research seeks to fill this gap by adopting a life course approach, evaluating how socioeconomic disadvantage during childhood and transitions in SES across adulthood contribute to premature death.

3. Data

The study uses data from the Atherosclerosis Risk in Communities (ARIC) study, a large, multicenter cohort that tracks cardiovascular health outcomes across four U.S. communities: Washington County, Maryland; Forsyth County, North Carolina; Jackson, Mississippi; and the northwestern suburbs of Minneapolis, Minnesota. The ARIC study initially recruited participants aged 45-64 years during 1987-1989 and followed them for various health outcomes. For this analysis, the research draws on the Life Course Socioeconomic, Social Context, and Cardiovascular Disease (LCSES) ancillary study conducted as part of the ARIC, incorporating addresses and SES measures collected from 12,610 Black and White participants between 1996 and 2020.

The neighborhood SES scores were linked to participants' residential addresses during three key life stages: childhood (approximately age 10), young adulthood (approximately age 30), and middle adulthood (ages 40-50). The neighborhood SES data were sourced from U.S. Census indicators, including variables such as educational attainment, home ownership rates, median income, occupation type, and property values. The study also considers the duration and consistency of exposure to neighborhood disadvantage by examining the SES transitions between these life epochs.

4. Methods

The researchers utilized Cox proportional hazards models to estimate hazard ratios (HRs) for premature mortality risk based on neighborhood SES scores. These scores were categorized into tertiles (low, middle, and high) and analyzed for each life epoch (childhood, young adulthood, and middle adulthood) independently. The models adjusted for multiple variables, including age, sex, race, marital status, income, and study center location.

The primary outcome of interest was premature mortality, defined as death from any cause occurring before age 75. Premature death data were sourced from the National Death Index, obituaries, and medical records collected throughout the follow-up period. Multiple imputation methods were applied to address missing SES data, particularly for young adulthood when some historical addresses could not be successfully geocoded due to census coverage limitations. Statistical analyses were performed using R and SAS software.

5. Findings/Size Effects

The study found a significant association between low neighborhood SES during middle adulthood and an elevated risk of premature mortality (HR, 1.28; 95% CI, 1.07-1.54) when compared to the highest SES tertile. This suggests that adults living in socioeconomically disadvantaged neighborhoods during middle adulthood are at greater risk of dying prematurely.

The analysis also showed that low SES in young adulthood increased the mortality risk specifically among women (HR, 1.25; 95% CI, 1.00-1.56). This indicates that women may be particularly vulnerable to the effects of neighborhood socioeconomic disadvantage during early adulthood. Furthermore, the risk of premature mortality was highest among participants who experienced persistently low SES from young to middle adulthood compared to those who remained in higher SES neighborhoods (HR, 1.25; 95% CI, 1.05-1.49). Interestingly, while childhood SES alone did not show a significant association with mortality overall, it was significant among White participants, highlighting potential racial differences in the effects of early-life neighborhood SES.

Sex and race-specific analyses further revealed that the associations between neighborhood SES and premature mortality were more pronounced among women than men. For instance, the lowest SES tertile in middle adulthood was linked to a higher mortality risk among women (HR, 1.39; 95% CI, 1.07-1.81) even after adjusting for sociodemographic factors. Comparatively, when stratified by race, Black and White participants showed similar trends; however, the association between low SES during childhood and premature mortality was only significant among White individuals.

6. Conclusion

The study concludes that neighborhood SES across the life course plays a critical role in determining premature mortality risk. Low SES during middle adulthood is a particularly strong predictor, and the greatest mortality risk is observed among those exposed to consistent socioeconomic disadvantage from young to middle adulthood. These findings underscore the importance of life course interventions aimed at alleviating neighborhood-level socioeconomic disparities to reduce premature mortality rates.

The authors suggest that future research and public health policies should consider place-based strategies that address neighborhood SES from early life through adulthood to mitigate the impact of socioeconomic disadvantage on health outcomes. By targeting neighborhoods for improvement and providing resources early in life, it may be possible to improve long-term health and reduce premature deaths.