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Mortality and Where You Live – It’s Location, Location, Location

March 23, 2023

Where you live matters–it often determines access to “good” schools, well-stocked grocery stores, and safe places to play and exercise.

This week in Pediatrics, we are early releasing an article entitled, “Neighborhood Opportunity and Mortality among Children and Adults in their Households,” by Natalie Slopen ScD and colleagues from Harvard University, U.S. Census Bureau, and Brandeis University that takes the adage “where you live matters” one step further (10.1542/peds.2022-058316).

The authors looked at the neighborhoods for approximately 1 million US children and used the Child Opportunity Index (COI), which uses 29 indicators to measure the overall quality of neighborhood resources and conditions pertaining to education, health and environment, and social and economic factors

These 29 indicators include such items as:

  • Number of early childhood education centers within a 5-mile radius,
  • Percentage of ninth graders graduating from high school on time
  • Percentage of housholds without a car located >1/2 mile from the nearest supermarket
  • Proximity to hazardous waste dump sites.

The authors used these indicators to rate each neighborhood as being in one of 5 categories, ranging from very low opportunity to very high opportunity. They then assessed the association of the COI with deaths of children and adults in the household.

What did the authors find? You will probably not be surprised to learn that, compared with children who live in very high opportunity neighborhoods, those who live in the very low opportunity neighborhoods have a 15% increased risk of dying, and they are 30% more likely to experience the death of an adult in their household.

What can we do with this information? In an invited commentary (10.1542/peds.2022-060498), Jeffrey Brosco, MD, PhD and Shirley Payne, PhD from the Maternal and Child Health Bureau, Health Resources and Service Administration note that the list of the 29 indicators (which you can see in Table 1 of Slopen’s article) can “remind us of the range of targets to improve health, from school poverty and neighborhood walkability to toxic exposures and health insurance coverage.”

Drs. Brosco and Payne also urge us to think differently about individual responsibility. In the US, there is so much emphasis on individual responsibility – for instance, we make each person responsible for their health, and we make parents responsible for their children’s health. As Slopen and colleagues have demonstrated, it’s not that simple. It will take local, state, and even national resources and interventions to improve opportunity and resources in every neighborhood.

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