Child, caregiver mortality up in low-opportunity neighborhoods

Children living in neighborhoods with low opportunities for health have an increased risk for child and caregiver mortality, according to a study published online March 22 in Pediatrics.

Natalie Slopen, Sc.D., from the Harvard T.H. Chan School of Public Health in Boston, and colleagues examined the association between neighborhood opportunity and mortality risk in children and their caregivers over 11 years using data from 1,025,000 children drawn from the Mortality Disparities in American Communities study. The Child Opportunity Index was used to measure neighborhood opportunity, which captures compounding inequities in access to opportunities for health.

The researchers observed inverse associations between the Child Opportunity Index quintile and child and caregiver deaths. The risk for dying during follow-up was increased 1.30-fold (95 percent confidence interval, 1.15 to 1.45) for children in very low-opportunity neighborhoods at baseline relative to those in very high-opportunity neighborhoods; after adjustment for household characteristics, the excess risk was attenuated (hazard ratio, 1.15; 95 percent confidence interval, 0.98 to 1.34).

Relative to those in very high-opportunity neighborhoods, children in very low-opportunity neighborhoods had an increased risk for experiencing the death of a caregiver (hazard ratio, 1.57; 95 percent confidence interval, 1.50 to 1.64), which persisted after adjustment (hazard ratio, 1.30; 95 percent confidence interval, 1.23 to 1.38).

"The marked discrepancies in neighborhood opportunity by race and ethnicity," write the authors, "call for greater attention to the influence of structural inequities associated with residential segregation driven by racism that perpetuate the disparities in mortality among neighborhoods observed in this study."

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