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

项目概要/摘要 人口按种族-族裔划分的空间隔离是卫生不平等的一个根本原因 通过在多个层面上相互关联的健康社会决定因素的级联，在整个生命过程中发挥作用。虽然 在过去的20年里，社区健康多层次研究已经激增，但它仍然很薄弱 方法论上：使用前瞻性方法解决生命过程中的一个点，而不是很长的时间段 数据;未能整合社会过程和生物数据;不关注异质性或途径;以及 脱离政策解决方案。我们对中年死亡率基于地点的不平等的研究 这些限制，利用数据从一个有前途的政策实验：移动到机会（MTO） study. MTO跟踪了4600个低收入少数种族家庭，他们在基线时居住在公共住房中， 美国大城市，他们被随机分配到三种治疗方法中的一种：两种住房券中的一种 以提高住房负担能力和邻里机会，或在适当的控制组，留在 公屋在基线（1994年）、2001 - 2002年和2008 - 2010年进行了评价调查。本研究 通过将其与28年来的三个行政数据集联系起来，扩展和丰富了MTO数据-（1）NCHS的 国家死亡指数，（2）社会保障的数字，（3）人口普查主地址文件-使我们能够 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 和生产人口健康和社会流行病学学者领导我们的成就，跨学科 团队我们的项目有五个具体目标：目标1：测试MTO低贫困住房券待遇 在2023年改善邻里机会，而不是现有的公共住房或标准凭证 目标2：测试MTO低贫困住房券治疗是否降低了中年死亡风险 与现有公共住房或标准代金券组相比;目标3：检查或多或少 可能受益于MTO住房券试验，即，检验MTO对死亡率影响的异质性 目标4：检验生命过程中的许多多层次因素中的哪一个起中介作用 MTO住房券试验对死亡率的影响;目标5：计算 如何在人口水平上缩小种族/族裔死亡率差距， 广泛实施了以凭证为基础的住房政策，以促进有机会的搬迁。拟建项目 与NIA人口和社会进程分支保持一致，以阐明"生命历程途径， 健康结果的差异"。我们的研究为人口健康提供了一个独特而重要的机会： 理解一个长长的因果链，从随机分配住房券，以改变 邻里环境和基于区域的背景下的生物，身体，心理健康，和行为 通往死亡的道路

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.