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

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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.