Housing policy, neighborhood context, and pathways to midlife mortality in a social experiment

项目摘要/摘要 人口沿种族-民族界线的空间分离是健康不平等的根本原因 在整个生命过程中，通过在多个层面上相互关联的健康社会决定因素的级联。虽然 社区卫生多层次研究在过去20年里激增，但仍然薄弱 方法论：解决生命过程中的一个点，而不是使用前瞻性 数据；未能整合社会进程和生物数据；不考虑异质性或途径；以及 与政策解决方案脱节。我们对中年死亡率基于地点的不平等的研究解决了 这些限制利用了来自一项有前景的政策实验的数据：转向机会(MTO) 学习。MTO跟踪调查了4600个低收入少数族裔家庭，这些家庭住在基线水平的公共住房中， 美国大城市，他们随机接受三种治疗中的一种：两种住房代金券之一 改善住房可负担性和邻里机会，或保留在 公共房屋。评价调查是在基线(1994年)、2001-02年和2008-10年进行的。本研究 通过将MTO数据链接到28年来的三个管理数据集来扩展和丰富MTO数据-(1)NCHS 国家死亡指数，(2)社会保障的数字，和(3)人口普查总地址文件-允许我们 分析住房流动性对中年死亡率和长期居住流动性的影响。一位经验丰富的人 和生产性人口健康和社会流行病学家学者领导着我们成就卓著的跨学科 一队。我们的项目有五个具体目标：目标1：测试MTO低贫困住房代金券待遇 与就地公共住房或标准代金券相比，在2023年改善社区机会 目标2：测试MTO低贫困住房代金券治疗是否降低了中年死亡风险 与就地公共住房或标准代金券小组比较；目标3：审查或多或少 可能受益于MTO住房代金券试验，即测试MTO对死亡率影响的异质性 通过基线人口统计因素；目标4：测试生命过程中许多多水平因素中哪些因素起中介作用 MTO住房代金券实验对死亡率的影响；目标5：计算 以及种族/族裔死亡率差距将如何在人口层面缩小，如果 广泛实施以代金券为基础的住房政策，以促进机会转移。拟议中的项目 与NIA人口和社会进程分支机构保持一致，以阐明“导致 在健康结果方面的差异。我们的研究为人口健康提供了一个独特而重要的机会： 了解从随意分配购房券到改变住房政策的一系列因果关系 社区环境和基于区域的环境对生物、身体、心理健康和行为的影响 通向死亡的道路。

PROJECT SUMMARY/ABSTRACT The spatial separation of populations along racial-ethnic lines is a fundamental cause of health inequities across the life course via cascades of interlocking social determinants of health at multiple levels. Although neighborhood-health multilevel research has proliferated in the past 20 years, it remains weak methodologically: addressing one point in the life course rather than a long temporal period using prospective data; failing to integrate social processes and biological data; not attending to heterogeneity or pathways; and remaining divorced from policy solutions. Our study of place-based inequities in mid-life mortality addresses these limitations, leveraging data from a promising policy experiment: The Moving to Opportunity (MTO) Study. The MTO follows 4600 low-income racial minority families, living in public housing at baseline, in five large US cities, who were randomized to receive one of three treatments: one of two types of housing vouchers to improve housing affordability and neighborhood opportunity or an in-place control group that remained in public housing. Evaluation surveys were conducted at baseline (1994), in 2001-02, and in 2008-10. This study expands and enriches the MTO data by linking it to three administrative datasets across 28 years—(1) NCHS’s National Death Index, (2) Social Security’s Numident, and (3) the Census Master Address File—allowing us to analyze the effects of housing mobility on mid-life mortality and long-term residential mobility. An experienced and productive population health and social epidemiologist scholar leads our accomplished, interdisciplinary team. Our project has five specific aims: Aim 1: Test if the MTO low-poverty housing voucher treatment improves neighborhood opportunity in year 2023, versus the in-place public housing or standard voucher group; Aim 2: Test if the MTO low-poverty housing voucher treatment reduces mortality risk through mid-life versus in-place public housing or the standard voucher group; Aim 3: Examine subgroups that are more or less likely to benefit from the MTO housing voucher experiment, i.e., test heterogeneity of MTO effects on mortality by baseline demographic factors; Aim 4: Test which of many multilevel factors across the life course mediate the effect of the MTO housing voucher experiment on mortality; Aim 5: Calculate the number of deaths that would be avoided and how the racial/ethnic mortality gap would be narrower, at the population level, if voucher-based housing policy were broadly implemented to promote opportunity moves. The proposed project aligns with NIA Population and Social Processes Branch to elucidate “life course pathways leading to disparities in health outcomes.” Our study presents a unique and important opportunity for population health: to understand a long chain of causation from random assignment of a housing voucher to a change in neighborhood environment and area-based contexts to the biological, physical, mental health, and behavioral pathways to mortality.