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American Journal of Epidemiology Advance Access published online on January 18, 2006
American Journal of Epidemiology, doi:10.1093/aje/kwj054
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American Journal of Epidemiology Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.
Received May 24, 2005
Accepted September 23, 2005

ORIGINAL CONTRIBUTIONS

Neighborhood Conditions and Risk of Incident Lower-Body Functional Limitations among Middle-aged African Americans

Mario Schootman 1 *, Elena M. Andresen 2, Fredric D. Wolinsky 3, Theodore K. Malmstrom 4, J. Philip Miller 5, and Douglas K. Miller 6

1 Department of Medicine and Pediatrics, Washington University School of Medicine, St. Louis, MO
2 North Florida/South Georgia Veterans Health System, Gainesville, FL; College of Public Health and Health Professions, University of Florida, Gainesville, FL
3 Department of Health Management and Policy, College of Public Health, The University of Iowa, Iowa City, IA
4 Department of Psychiatry, School of Medicine, Saint Louis University, St. Louis, MO
5 Division of Biostatistics, Washington University School of Medicine, St. Louis, MO
6 Indiana University Center for Aging Research, Regenstrief Institute for Health Care, Indiana University School of Medicine, Indianapolis, IN

* To whom correspondence should be addressed.
Mario Schootman, E-mail: mschootm{at}im.wustl.edu


  Abstract

The authors investigated the association between observed neighborhood conditions and lower-body functional limitations (LBFLs) using data from 563 subjects of the African-American Health Study. This population-based cohort received in-home evaluations. Five items involving LBFL were obtained at baseline (2000-2001) and 3 years later. Subjects were considered to have LBFL if they reported difficulty on at least two of the five tasks. The external appearance of the block the respondent lived on was rated during sample enumeration by use of five items (rated excellent, good, fair, or poor). Of 563 subjects with 0-1 LBFL at baseline, 15% and 14% lived in neighborhoods with 4-5 and 2-3 fair/poor conditions, respectively. Logistic regression adjusting for propensity scores showed that persons who lived in neighborhoods with 4-5 versus 0-1 fair/poor condition were 3.07 times (95% confidence interval: 1.58, 5.94) more likely to develop two or more LBFLs. The odds ratio was 2.24 (95% confidence interval: 1.07, 4.70) when living in neighborhoods with 2-3 conditions versus 0-1 fair/poor condition. Odds ratios for individual neighborhood characteristics varied from 3.45 (fair/poor street conditions) to 2.01 (fair/poor noise level). Sensitivity analyses showed the robustness of the findings. Poor neighborhood conditions appear to be an independent contributor to the risk of incident LBFLs in middle-aged African Americans.

Keywords: African Americans; aging; health status indicators; questionnaires; residence characteristics; social environment.
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