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a Stanford Center for
Research in Disease Prevention, Stanford University School of Medicine,
1000 Welch Road, Palo Alto, CA 94304-1825, USA, b Laboratory for Social Research and Department of
Sociology, University of Notre Dame, c Center for Injury Research and Policy, The Johns
Hopkins University School of Hygiene and Public Health
Correspondence to: Dr Cubbin (ccubbin{at}leland.stanford.edu)
Accepted for publication 17 February 2000
STUDY OBJECTIVE
This
study examined both individual and neighbourhood correlates of injury
mortality to better understand the contribution of socioeconomic status
to cause specific injury mortality. Of particular interest was whether
neighbourhood effects remained after adjusting for individual
demographic characteristics and socioeconomic status.
DESIGNCensus tract
data (measuring small area socioeconomic status, racial concentration,
residential stability, urbanisation, and family structure) was merged
with the National Health Interview Survey (NHIS) and a file that links
the respondents to subsequent follow up of vital status and cause of
death data. Cox proportional hazards models were specified to determine
individual and neighbourhood effects on homicide, suicide, motor
vehicle deaths, and other external causes. Variances are adjusted for
the clustered sample design of the NHIS.
SETTINGUnited States,
1987-1994, with follow up to the end of 1995.
PARTICIPANTSFrom a
sample of 472 364 persons ages 18-64, there were 1195 injury related
deaths over the follow up period.
MAIN
RESULTSIndividual level effects were generally
robust to the inclusion of neighbourhood level variables in the models.
Neighbourhood characteristics had independent effects on the outcome
even after adjustment for individual variability. For example, there
was approximately a twofold increased risk of homicide associated with
living in a neighborhood characterised by low socioeconomic status,
after adjusting for individual demographic and socioeconomic characteristics.
CONCLUSIONSSocial
inequalities in injury mortality exist for both persons and places.
Policies or interventions aimed at preventing or controlling injuries
should take into account not only the socioeconomic characteristics of
people but also of the places in which they live.
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