The health implications of cumulative exposure to contextual (dis)advantage: methodological and substantive advances from a unique data linkage.

Abstract

Deleterious neighborhood conditions are associated with poor health, yet the health impact of cumulative lifetime exposure to neighborhood disadvantage is understudied. Using up to 5 decades of residential histories for 4177 adult participants in the Survey of the Health of Wisconsin (SHOW) and spatiotemporally linked neighborhood conditions, we developed 4 operational approaches to characterizing cumulative neighborhood (dis)advantage over the life course. We estimated their associations with self-reported general health and compared them with estimates using neighborhood (dis)advantage at the time of study enrollment. When cumulative exposures were assessed with the most granular temporal scale (approach 4), neighborhood transportation constraints (odds ratio [OR] = 1.21; 95% CI, 1.08-1.36), residential turnover (OR = 1.20; 95% CI, 1.07-1.34), education deficit (OR = 1.17; 95% CI, 1.04-1.32), racial segregation (OR = 1.20; 95% CI, 1.04-1.38), and median household income (OR = 0.85; 95% CI, 0.75-0.97) were significantly associated with risk of fair or poor health. For composite neighborhood disadvantage, cumulative exposures had a stronger association (OR = 1.05; 95% CI, 1.02-1.08) than the cross-sectional exposure (OR = 1.03; 95% CI, 1.01-1.06). Single-point-in-time neighborhood measures underestimate the relationship between neighborhood and health, underscoring the importance of a life-course approach to cumulative exposure measurement.