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American Journal of Epidemiology Advance Access originally published online on August 6, 2008
American Journal of Epidemiology 2008 168(6):611-619; doi:10.1093/aje/kwn182
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American Journal of Epidemiology © The Author 2008. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

The Link between Neighborhood Poverty and Health: Context or Composition?

D. Phuong Do1 and Brian Karl Finch2

1 Institute for Social Research, School of Public Health, University of Michigan, Ann Arbor, MI
2 Department of Sociology, College of Arts and Letters, San Diego State University, San Diego, CA

Correspondence to Dr. D. Phuong Do, 3626 SPH Tower, University of Michigan, 109 Observatory Street, Ann Arbor, MI 48109-2029 (e-mail: phoenixd{at}umich.edu).

Received for publication July 27, 2007. Accepted for publication May 28, 2008.

Cross-sectional studies of neighborhood context and health are subject to upward bias due to unobserved heterogeneity and to downward bias due to overadjustment for potential mediators in the pathway between neighborhood context and health. In this study, the authors employed two strategies that addressed these two sources of bias. First, to mitigate overadjustment of mediators, they adjusted for baseline characteristics observed just prior to the measurement of neighborhood context, using a combined propensity score and regression strategy. Second, to mitigate underadjustment of unmeasured confounders, they employed a fixed-effects modeling strategy to account for unobserved non-time-varying heterogeneity. Analyses were based on a nationally representative sample of the nonimmigrant US population from the Panel Study of Income Dynamics (1980–1997) in which respondent-rated health was regressed on neighborhood poverty. The samples consisted of approximately 6,000 respondents for the propensity score/regression models and 45,000 person-years for the fixed-effects models. Both modeling strategies yielded significant estimates of neighborhood poverty and supported a causal link between neighborhood context and health.

causality; health status disparities; poverty; residence characteristics; social class

Abbreviations: CI, confidence interval; MTO, Moving to Opportunity; OR, odds ratio; PSID, Panel Study of Income Dynamics


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