"Who are the people in your neighborhood…they're the people that you meet when you're walking down the street…" — The Muppets of Sesame Street
When most people take a walk around their neighborhood, it might be to get some exercise. Maybe to pick up the mail, visit with a friend, or just to get some fresh air. Sometimes a person might be cooling off after a family squabble, or making a mental grocery list.
However, when Alanna Chamberlain, Ph.D., an epidemiologist and health services researcher at Mayo Clinic, and her colleagues walk around their neighborhoods, it may be for a different purpose. They may instead be thinking of questions these neighborhoods might want answered, of needs their neighbors might have, and how a multidisciplinary research team might come up with solutions.
In a study published recently in BMC Public Health, Dr. Chamberlain and her team discussed some of their neighborhood-based research. They found that in any particular geographically-defined community, how many chronic medical conditions its residents have are related to the socioeconomic disadvantages of that particular neighborhood.
"We found a number of interesting results," says Dr. Chamberlain. "First, we found that where you live – your neighborhood – influences your health. Second, we found that where you live is more important for younger people than for older people."
The researchers found the associations between neighborhood and multimorbidity – several chronic medical conditions – were strongest in younger persons, while for people over age 70, it didn't seem to matter where they lived.
"Interestingly," says Dr. Chamberlain, "We observed that where you live was more important for women compared to men."
She also notes that in people who were highly educated (those with a college degree or advanced degree), there was less neighborhood-related risk associated with multimorbidity.
The data behind the study
To come to their conclusions, the researchers used the Rochester Epidemiology Project to identify the records of 198,941 adults age 20 or older residing in seven counties.
They paired this information with results of the American Community Survey to determine the area deprivation index for each of the 251 census block groups included in their study. The area deprivation index is a way to measure the health of a neighborhood, with each indicator a potential symptom that if left untreated contributes to community as well as individual decline.
A census block group is determined by the number of people residing in an area, or neighborhood. Census block groups generally have between 600 and 3000 people; for the 7-county area in the study, the median size was 707 persons, with a range between 109 and 2,520 residents in a particular census block.
The research team used indicators such as income levels, access to basics like a car, parenting and employment status, education, and more.
"The area deprivation index includes 17 variables that are weighted, summed together, and standardized into an overall score," says Dr. Chamberlain.
They defined multimorbidity as the presence of two or more chronic conditions, and severe multimorbidity as five or more from a list of 21. Of these, the United States Department of Health and Human Services identifies 20, and the researchers added anxiety, because of its prevalence in the U.S.
Key findings include:
Why does this matter?
"We know that socioeconomic status is related to health, and multiple studies have found an increasing risk of multimorbidity for persons with low education," says Dr. Chamberlain. "However, there is also evidence that neighborhood environment influences health; yet, there are fewer studies linking neighborhood measures of socioeconomic status with multimorbidity."
Each person's experiences are different, and many factors can lead to different health outcomes, even among people in the same home. For health care providers, it is difficult to know enough context to offer interventions appropriate to each patient's unique needs. Dr. Chamberlain believes that population health research such as this study allows more in depth understanding, and can lead to more personalized care for people in specific populations, including neighbors.
Although the investigators' findings are similar in many respects to studies done in a few other countries, it is unique to Americans.
"To our knowledge, this study is only the second one in the United States that links an area-level measure of socioeconomic status with multimorbidity," says Dr. Chamberlain.
The first study was also conducted using the Rochester Epidemiology Project. The researchers developed a novel measure of socioeconomic status – the HOUSES index, which they paired with data from a single county (Olmsted).
Dr. Chamberlain and her colleagues hope that health care providers may be able to use these new findings to better individualize care plans.
"Interventions to either prevent the onset of multimorbidity or to manage chronic conditions should be targeted at younger persons, and in particular at younger women," they write.
And, coupled with other clinical variables, knowing a bit more about a patient's neighborhood may help clinicians identify patients at high risk for developing chronic conditions or who may have difficulty adhering to prescribed medications.
Tags: Alanna Chamberlain, area deprivation index, Center for the Science of Health Care Delivery, epidemiology, Findings, multiple chronic conditions, News, population health, Rochester Epidemiology Project