No Man is an Island: The Impact of Neighborhood Disadvantage on Mortality.


Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. [Email]


This study's purpose is to determine if neighborhood disadvantage, air quality, economic distress, and violent crime are associated with mortality among term life insurance policyholders, after adjusting for individual demographics, health, and socioeconomic characteristics. We used a sample of approximately 38,000 term life policyholders, from a large national life insurance company, who purchased a policy from 2002 to 2010. We linked this data to area-level data on neighborhood disadvantage, economic distress, violent crime, and air pollution. The hazard of dying for policyholders increased by 9.8% (CI: 6.0–13.7%) as neighborhood disadvantage increased by one standard deviation. Area-level poverty and mortgage delinquency were important predictors of mortality, even after controlling for individual personal income and occupational status. County level pollution and violent crime rates were positively, but not statistically significantly, associated with the hazard of dying. Our study provides evidence that neighborhood disadvantage and economic stress impact individual mortality independently from individual socioeconomic characteristics. Future studies should investigate pathways by which these area-level factors influence mortality. Public policies that reduce poverty rates and address economic distress can benefit everyone's health.


health,mortality,neighborhood disadvantage,social determinants,socioeconomic status,