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This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: AJPH.2004.060970v1 96/12/2145    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (9) Citing Articles via Google Scholar Google Scholar Articles by Winkleby, M. Articles by Ahn, D. Search for Related Content PubMed PubMed Citation Articles by Winkleby, M. Articles by Ahn, D.

Marilyn Winkleby, MPH, PhD, Catherine Cubbin, PhD and David Ahn, PhD

Marilyn Winkleby and David Ahn are with the Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, Calif. Catherine Cubbin is with the Center on Social Disparities in Health, Department of Family and Community Medicine, University of California, San Francisco, and with the Population Research Center, University of Texas, Austin.

Correspondence: Requests for reprints should be sent to Marilyn Winkleby, Stanford Prevention Research Center, Stanford University School of Medicine, 211 Quarry Road, Stanford, CA 94305–5705 (e-mail: winkleby{at}stanford.edu).

Objective. We examined whether the influence of neighborhood-level socioeconomic status (SES) on mortality differed by individual-level SES.

Methods. We used a population-based, mortality follow-up study of 4476 women and 3721 men, who were predominately non-HIspanic White and aged 25–74 years at baseline, from 82 neighborhoods in 4 California cities. Participants were surveyed between 1979 and 1990, and were followed until December 31, 2002 (1148 deaths; mean follow-up time 17.4 years). Neighborhood SES was defined by 5 census variables and was divided into 3 levels. Individual SES was defined by a composite of educational level and household income and was divided into tertiles.

Results. Death rates among women of low SES were highest in high-SES neighborhoods (1907/100000 person-years), lower in moderate-SES neighborhoods (1323), and lowest in low-SES neighborhoods (1128). Similar to women, rates among men of low SES were 1928, 1646, and 1590 in high-, moderate-, and low-SES neighborhoods, respectively. Differences were not explained by individual-level baseline risk factors.

Conclusion. The disparities in mortality by neighborhood of residence among women and men of low SES demonstrate that they do not benefit from the higher quality of resources and knowledge generally associated with neighborhoods that have higher SES.

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