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Neighborhood Environment and Health Status and Mortality Among Veterans

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Abstract

BACKGROUND

The VHA is the largest integrated US health system and is increasingly moving care into the communities where veterans reside. Veterans who utilize the VA for their care have worse health status than the general population. However, there is limited evidence about the association of neighborhood environment and health outcomes among veterans.

OBJECTIVES

The primary aim of this study is to assess the relative contribution of neighborhood environment, health system, and individual characteristics to health status and mortality of veterans.

METHODS

Information on personal socio-economic indicators, existing medical conditions and health status were obtained from baseline data from a multi-site, randomized trial of primary care patients (n = 15,889). The physical component scale (PCS) and mental component scale (MCS) summarized health status. Census tracts were used as proxies for neighborhoods. A summary score based on census tract data characterized the neighborhood socio-economic environment and walkability. Data were analyzed with multilevel hierarchical models. Analyses of health status were cross-sectional. Mortality analyses were longitudinal as participants were followed for an average of 722.5 days to ascertain vital status.

RESULTS

Neighborhood SES was associated with PCS and MCS scores, controlling for individual socio-economic status, self-reported co-morbid disease, smoking status, and health care access. In the lowest versus highest quartiles of neighborhood SES, adjusted PCS scores were 34.4 vs. 35.4 (p < 0.05) and adjusted MCS scores were 46.2 versus 47.0 (p < 0.05). PCS score was also significantly associated with neighborhood walkability (p < 0.05). Mortality was lower for veterans living in neighborhoods with the highest decile neighborhood SES (HR 0.78, highest vs. lowest decile 95% CI 0.63, 0.97).

CONCLUSIONS

Veterans living in lower SES neighborhoods have poorer health status and a higher risk of mortality, independent of individual characteristics and health care access. Neighborhood walkability was associated with higher PCS scores.

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Acknowledgements

This material is based upon work supported by the U.S. Department of Veterans Affairs, Office of Research and Development VA Health Services Research and Development Program (IIR 04-436-3) and the Seattle Epidemiologic Research and Information Center. This work was presented at the Society for General Internal Medicine National Meeting (May, 2009) and at the VA HSR&D National Meeting (February, 2009). The views expressed in this article are those of the author and do not necessarily represent the views of the Department of Veterans Affairs.

Conflicts of Interest Statement

None Disclosed.

Author information

Authors and Affiliations

  1. Health Services Research and Development, VA Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA, 98108, USA

    Karin Nelson MD, MSHS, Leslie Taylor PhD & Stephan D. Fihn MD. MPH

  2. General Medicine Service, VA Puget Sound Health Care System, Seattle, WA, USA

    Karin Nelson MD, MSHS & Stephan D. Fihn MD. MPH

  3. Department of Medicine, University of Washington, Seattle, WA, USA

    Karin Nelson MD, MSHS, Lynne McFarland PhD & Stephan D. Fihn MD. MPH

  4. Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA, USA

    Karin Nelson MD, MSHS

  5. US Department of Health and Human Services, Washington, DC, USA

    Nicole Lurie MD, MSPH

  6. RAND Health, Santa Monica, CA, USA

    José Escarce MD, PhD

Authors
  1. Karin Nelson MD, MSHS
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  2. Leslie Taylor PhD
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  3. Nicole Lurie MD, MSPH
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  4. José Escarce MD, PhD
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  5. Lynne McFarland PhD
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  6. Stephan D. Fihn MD. MPH
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Correspondence to Karin Nelson MD, MSHS.

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Nelson, K., Taylor, L., Lurie, N. et al. Neighborhood Environment and Health Status and Mortality Among Veterans. J GEN INTERN MED 26, 862–867 (2011). https://doi.org/10.1007/s11606-011-1710-0

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  • DOI: https://doi.org/10.1007/s11606-011-1710-0

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