Association between district-level perceived safety and self-rated health: a multilevel study in Seoul, South Korea

OBJECTIVES Several studies have reported the relationship between residents' perceived neighbourhood safety and their health outcomes. However, those studies suffered from unreliability of neighbourhood safety measure and potential residual confounding related to crime rates. In this study, using multilevel analysis to account for the hierarchical structure of the data, we examined associations between district-level perceived safety and self-rated health after adjusting for potential confounders including the district-level crime rate. DESIGN Cross-sectional study. SETTING We used the first wave of Seoul Welfare Panel Study, which has 7761 individuals from 3665 households in 25 administrative districts in Seoul, South Korea. District-level perceived safety was obtained by aggregating responses from the residents that are representative samples for each administrative district in Seoul. To examine an association between district-level safety and residents' self-rated health, we used mixed effect logistic regression. RESULTS Our results showed that higher district-level perceived safety, an aggregated measure of district residents' responses towards neighbourhood safety, was significantly associated with poor self-rated health after controlling for sex, age, education level, job status, marital status and household income (OR=0.87, 95% CI 0.78 to 0.97). Furthermore, this association was still robust when we additionally adjusted for the district-level crime rate (OR=0.86, 95% CI 0.77 to 0.95). CONCLUSIONS Our study highlights the importance of improving neighbourhood perceived safety to enhance residents' health.