The Impacts of Early Neighborhoods on Racial Disparities in Adult Health Outcomes

University Of Wisconsin-Madison, Madison WI

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Abstract

? DESCRIPTION (provided by applicant): We have come to understand that racial disparities in adult health outcomes are affected by exposures and experiences over the life span. Early life exposures and experiences 1) affect later health outcomes 2) accumulate over time and 3) vary tremendously by racial group. Life course research has focused primarily on specific aspects of childhood family contexts that demonstrate the long arm of childhood exposures on adult health. Meanwhile, there is recognition that neighborhood context may contribute to racial disparities in health over the life course. Studies demonstrate that childhood neighborhood context is associated with child health, and adulthood neighborhood context is associated with adult health. However, these primarily cross-sectional studies demonstrate nonexistent or only modest associations between neighborhood context and health. Notably, few studies examine how neighborhood context in childhood affects racial disparities in adult health, or how racial disparities in childhood neighborhood context may contribute to racial disparities in adult health. Previous work has been hampered by lack of access to appropriate longitudinal data, and methodological limitations. This project extends prior research by using two complementary longitudinal datasets and novel methods to examine the long reach of contextual exposures in childhood on racial disparities in adult health outcomes. We have two specific aims: (1) Calculate upper bound estimates of the plausible total impact of all childhood contextual factors on black/white disparities in adult health outcomes. Borrowing economic and demographic methods used in educational research, we examine correlations between geographically close and geographically distant individuals to evaluate the extent to which the totality of childhood contextual factors affect adult cardiovascular, metabolic, mental, and self-rated status health outcomes and compare these correlations by racial group. (2) Estimate the contribution of long-term exposure to neighborhood disadvantage during childhood on black/white racial disparities in adult health outcomes. While Aim 1 establishes plausible upper bounds for childhood contextual effects on a variety of adult health outcomes, it does not address duration of exposure and remains agnostic about the specific nature of relevant exposures. Aim 2 extends Aim 1 by using information on neighborhood exposures over time-up to two decades--and using new bio statistical methods to examine the effects of cumulative neighborhood disadvantage across the life course on racial disparities in adult health. The aim both examines the contribution of racial disparities in childhood cumulative neighborhood disadvantage on racial disparities in adult health and examines whether the impacts of cumulative neighborhood disadvantage differ between black and white individuals. Our analyses allow explicit comparisons of earlier contextual effects across health domains to ask which domains of racial health disparities appear most or least affected by childhood cumulative contextual factors.