Area-level Socio-economic Conditions and Individual-level Health and Mortality: Exploring Place-Based Mechanisms and Individual-level Psychosocial Processes

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PROJECT SUMMARY More than 1 million drug overdose deaths have occurred in the US since 1999, while progress in reducing mortality from cardiovascular disease and diabetes has stalled since 2010. This evidence of rising morbidity and mortality in midlife has drawn attention to health risks among the working-age population. Increasing geographic variation in premature mortality, most pronounced during early to mid-adulthood, highlights the role of place. Research is needed that systematically identifies how place-based features contribute to the US midlife health and mortality crisis. Drawing from socio-ecological perspectives of health, the present study will test a comprehensive conceptual framework to examine the direct, indirect, and moderating effects within the place and health relationship. We will use two unique datasets that allow us to address limitations that have stymied past efforts. First, the Midlife in the United States study (MIDUS) enrolled 7,108 adults in the contiguous US aged 25 to 74 in 1995-1996 and surveyed them again in 2004-2006 and in 2013-2014, adding a sample of 592 Black adults in 2004-2006 who were surveyed again in 2016-2017. Second, the Utah Population Database (UPDB) includes data from a variety of state vital and administrative records for over 12 million individuals over 100 years, linked by family and containing geocoded residential addresses. From the UPDB, we will create a sample of 1.6 million adults aged 25 to 74 residing in a four-county urban area in 2000, for whom mortality is tracked until 2020 with 142,330 deaths recorded. Both datasets enable place-based longitudinal health research. In examining the health outcomes of substance misuse, mental health, cardiometabolic health, and mortality, we will: identify the prospective effects of area-level socioeconomic conditions on individual-level health and mortality outcomes (Aim 1); and document the prospective effects of place-based built, social, and natural environments on individual-level health and mortality outcomes (Aim 2). Attention will be given to how environmental features moderate and mediate prospective effects of area-level socioeconomic conditions, and to the individual-level mediating processes. We will use innovative methods to measure a range of place-based features and improve estimation using rigorous statistical methods (e.g., multi-level structural equation modeling, spatial analysis, and advanced survival analysis). Through this comprehensive investigation, we will document how place-based factors drive midlife health and mortality disparities and provide valuable insights into the complex and dynamic relationships within systems of people and places. This holistic research effort will produce novel evidence to support the development of effective place-based interventions.