|
BACKGROUND/RATIONALE:
Recent advances in social epidemiology have increased interest in the contribution of neighborhood environment on health outcomes among adults. A substantial body of literature indicates that where one lives and the social and physical environment of your neighborhood has important implications for health. However, there is limited evidence about the association of neighborhood environmental factors with health status and mortality among veterans.
OBJECTIVE(S):
The primary aim of this study is to determine the relative contributions of neighborhood social and physical environments, health system factors, and individual characteristics to health status and mortality among veterans. The secondary aims are (1) to determine whether the association between neighborhood characteristics and veteran health status is modified by age or race/ethnicity and (2) to assess potential mediators of the association between neighborhood characteristics and health status, including health behaviors and physiologic endpoints, among veterans with chronic disease.
METHODS:
The proposed project is a longitudinal cohort study linking two secondary datasets. Data on veteran health status and mortality will be obtained from the Ambulatory Care Quality Improvement Project (ACQUIP), a multi-site, randomized trial of VA primary care patients to determine whether health status and patient satisfaction could be improved by giving primary care providers access to systematic assessments of their patients' health and functioning. The main analyses showed no effect of the intervention on any primary or secondary outcome. Data from ACQUIP has been geo-coded at the census block level. Detailed individual level data from ACQUIP will then be linked via census block indicators to a contextual database of neighborhood factors developed by Dr. Nicole Lurie and investigators at RAND. Dr. Lurie is the Principal Investigator for an NIH-funded Center for Population Health and Health Disparities at RAND whose goal is to advance understanding of the links between neighborhood environments, behavior and health. As part of this center grant, Dr. Lurie and colleagues have assembled a data library of neighborhood characteristics from a variety of national data sources that can be merged with health data sets at the census block level. Key conceptual components of this database include measures of neighborhood socioeconomic status (poverty, employment and education), social structures (segregation, residential stability) and neighborhood quality (crowding, level of urban development and crime).
FINDINGS/RESULTS:
We are currently analyzing data for this project.
IMPACT:
We are in the process of data analysis for this project. We hope this research will provide the first information about the relative contributions of neighborhood environmental factors, health system factors such as access and distance to care, and personal health risks on health status and mortality among veterans. The information from this study will be useful both in understanding the determinants of health in the veteran population and in providing information to support VA resource allocation and strategic planning to optimize veteran health.
PUBLICATIONS:
None at this time.
DRA:
Health Services and Systems, Special (Underserved, High Risk) Populations
DRE:
Epidemiology
Keywords:
Access, Minority, Quality of life
MeSH Terms:
none
|
