Racial disparities in context: a multilevel analysis of neighborhood variations in poverty and excess mortality among black populations in Massachusetts.

OBJECTIVES We analyzed neighborhood heterogeneity in associations among mortality, race/ethnicity, and area poverty. METHODS We performed a multilevel statistical analysis of Massachusetts all-cause mortality data for the period 1989 through 1991 (n=142836 deaths), modeled as 79813 cells (deaths and denominators cross-tabulated by age, gender, and race/ethnicity) at level 1 nested within 5532 block groups at level 2 within 1307 census tracts (CTs) at level 3. We also characterized CTs by percentage of the population living below poverty level. RESULTS Neighborhood variation in mortality across CTs and block groups was not accounted for by these areas' age, gender, and racial/ethnic composition. Neighborhood variation in mortality was much greater for the Black population than for the White population, largely because of CT-level variation in poverty rates. CONCLUSIONS Neighborhood heterogeneity in the relationship between mortality and race/ethnicity in Massachusetts is statistically significant and is closely related to CT-level variation in poverty.

[1]  D. Collett,et al.  Modelling Binary Data , 1991 .

[2]  Harvey Goldstein,et al.  Partitioning variation in multilevel models , 2002 .

[3]  Ian H. Langford,et al.  A User’s Guide to MLwiN, Version 2.10 , 2000 .

[4]  D. Collett.  Modelling Binary Data , 1991 .

[5]  G S Smith,et al.  Socioeconomic status and injury mortality: individual and neighbourhood determinants , 2000, Journal of epidemiology and community health.

[6]  William J. Blot,et al.  Atlas of Cancer Mortality in the United States 1950-94 , 2000 .

[7]  Jarvis T. Chen,et al.  Geocoding and monitoring of US socioeconomic inequalities in mortality and cancer incidence: does the choice of area-based measure and geographic level matter?: the Public Health Disparities Geocoding Project. , 2002, American journal of epidemiology.

[8]  H. Goldstein.  Multilevel Statistical Models , 2006 .

[9]  Gregory A. Elmes,et al.  Men and heart disease : an atlas of racial and ethnic disparities in mortality , 2001 .

[10]  Jarvis T. Chen,et al.  Monitoring socioeconomic disparities in death: comparing individual-level education and area-based socioeconomic measures. , 2006, American journal of public health.

[11]  Mark Monmonier,et al.  Cartographies of Danger: Mapping Hazards in America , 1997 .

[12]  R. Bosker.  Boekbespreking van "A.S. Bryk & S.W. Raudenbusch - Hierarchical linear models: Applications and data analysis methods" : Sage Publications, Newbury Parki, London/New Delhi 1992 , 1995 .

[13]  Patricia O'Campo,et al.  Invited commentary: Advancing theory and methods for multilevel models of residential neighborhoods and health. , 2003, American journal of epidemiology.

[14]  Kelvyn Jones,et al.  Multilevel Perspectives on Modeling Census Data , 2001 .

[15]  Risto Lethonen.  Multilevel Statistical Models (3rd ed.) , 2005 .

[16]  David R. Williams,et al.  Us socioeconomic and racial differences in health: patterns and explanations , 1995 .

[17]  S V Subramanian,et al.  Monitoring Socioeconomic Inequalities in Sexually Transmitted Infections, Tuberculosis, and Violence: Geocoding and Choice of Area-Based Socioeconomic Measures—The Public Health Disparities Geocoding Project (US) , 2003, Public health reports.

[18]  G. Singh,et al.  Trends and differentials in adolescent and young adult mortality in the United States, 1950 through 1993. , 1996, American journal of public health.

[19]  J Bound,et al.  Excess mortality among blacks and whites in the United States. , 1996, The New England journal of medicine.

[20]  G. Kaplan,et al.  Neighborhood social environment and risk of death: multilevel evidence from the Alameda County Study. , 1999, American journal of epidemiology.

[21]  Anthony S. Bryk,et al.  Hierarchical Linear Models: Applications and Data Analysis Methods , 1992 .

[22]  Linda W. Pickle,et al.  Atlas of United States Mortality , 1996 .

[23]  Craig Duncan,et al.  Multilevel methods for public health research , 2000 .

[24]  N. Krieger,et al.  Racism, sexism, and social class: implications for studies of health, disease, and well-being. , 1993, American journal of preventive medicine.

[25]  K. Greenlund,et al.  Atlas of Stroke Mortality: Racial, Ethnic and Geographic Disparities in the United States , 2003 .

[26]  S. Burris,et al.  Effects of an Intensive Street-Level Police Intervention on Syringe Exchange Program Use in Philadelphia, Pa , 2005, American journal of public health.

[27]  N. Smelser,et al.  America becoming : racial trends and their consequences , 2000 .

[28]  J W Hogan,et al.  On the wrong side of the tracts? Evaluating the accuracy of geocoding in public health research. , 2001, American journal of public health.

[29]  Jarvis T. Chen,et al.  Choosing area based socioeconomic measures to monitor social inequalities in low birth weight and childhood lead poisoning: The Public Health Disparities Geocoding Project (US) , 2003, Journal of epidemiology and community health.

[30]  Harvey Goldstein,et al.  Improved Approximations for Multilevel Models with Binary Responses , 1996 .