Neighborhood effects on the self-rated health of elders: uncovering the relative importance of structural and service-related neighborhood environments.

OBJECTIVES The purpose of this study was to investigate the independent relationship between neighborhood context (characterized through age structure, economic conditions, service provision, and residential stability) and self-reported health among elders in one U.S. city. METHODS By using multilevel statistical models, we examined the cross-sectional relationships between markers of neighborhood environment (derived from the 1980 U.S. Census and the Yellow Pages of the 1985 New Haven, Connecticut, telephone book) and self-rated health among elders. We used survey data from the 1985 New Haven Established Populations for Epidemiologic Studies of the Elderly, which comprised 1,926 elders nested within 28 census tracts. RESULTS When controlled for individual age, gender, race, marital status, education, and income, neighborhood measures of percent poverty were positively associated with poor self-rated health (odds ratio [OR] = 1.09; 95% confidence interval [CI] = 1.02-1.17), whereas residential stability (OR = 0.90; 95% CI = 0.84-0.96) and concentration of elders (OR = 0.82; 95% CI = 0.72-0.94) were inversely associated with poor self-rated health. Neighborhood service density was not associated with self-rated health. DISCUSSION We found support for the role of neighborhood structural context (reflected through measures of poverty, residential stability, and age-based demographic concentration) in predicting the health of elders. Density of neighborhood services did not appear to have an independent effect on the self-rated health of elders.