Association of perceived neighborhood problems and census tract income with poor self-rated health in adults: a multilevel approach

Höfelmann, Doroteia Aparecida; Roux, Ana V. Diez; Antunes, José Leopoldo Ferreira; Peres, Marco Aurélio

doi:10.1590/0102-311X00210913

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ARTICLE • Cad. Saúde Pública 31 (suppl 1) • Nov 2015 • https://doi.org/10.1590/0102-311X00210913 copy

Association of perceived neighborhood problems and census tract income with poor self-rated health in adults: a multilevel approach

Associação da percepção de problemas na vizinhança e renda de setor censitário com autoavaliação negativa de saúde em adultos: uma abordagem multinível

Asociación de la percepción de problemas en barrios y renta de las circunscripciones censales con la autoevaluación negativa de salud en adultos: un enfoque multinivel

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Neighborhood problems constitute sources of chronic stress that may increase the risk of poor self-rated health. The associations of census tract level income and perceived neighborhood problems with self-rated health were examined in Florianópolis, Santa Catarina State, Brazil (1,720 adults). Odds ratios (OR) and their 95% confidence intervals (95%CI) of poor self-rated health were estimated through multilevel models. Residents in census tracts in the lower and intermediate tertiles of income reported poorer health than those in the highest tertile. OR of reporting poorer health was 2.44 (95%CI: 2.35- 2.54) in the higher tertile of social disorder (adjusting for mental health). The chances of reporting the poorer health with neighborhood problems ranged from 1.07 (95%CI: 1.03-1.11) to 2.02 (95%CI: 1.95-2.10) for the higher tertile of social disorder (physical health) and physical problem (health-related variables). Perceived neighborhood problems were independently associated with poor health. The perception of a neighborhood among its residents should be considered by health policymakers.

Housing; Residence Characteristics; Socioeconomic Factors; Urban Health

Variables	Total (%) (N = 1,720)	Male (%) (n = 761)	Female (%) (n = 959)
Demographic
Gender
Male	44.5	-	-
Female	55.5	-	-
Race/Skin color
White	89.9	88.5	91.0
Brown	5.7	7.5	4.2
Black	4.4	4.0	4.8
Age groups (years)
20-29	32.7	34.8	31.0
30-39	22.9	22.8	22.9
40-49	25.0	23.7	26.0
50-59	19.4	18.6	20.1
Tertiles of neighborhood residence time (years)
0.00-5.00	37.4	39.3	36.0
5.01-16.50	29.7	30.2	29.4
16.51-59.00	32.8	30.5	34.7
Socioeconomic
Tertile of family per capita income
Lower	32.6	29.9	34.7
Intermediate	33.3	34.4	32.4
Higher	34.1	35.7	32.9
Educational attainment (years)
12 and more	43.9	43.0	44.6
9-11	33.4	34.5	32.5
5-8	14.0	13.7	14.2
0-4	8.8	8.8	8.7
Occupational status
Non manual	65.1	60.2	69.0
Manual	27.6	32.2	23.9
Other	7.3	7.6	7.1
Health-related behaviors
Alcohol abuse
No	81.5	70.4	90.4
Yes	18.5	29.6	9.6
Current smoking
No	80.8	78.6	82.5
Yes	19.2	21.4	17.6
Leisure physical activity
Active	46.9	46.3	58.6
Inactive	53.1	53.7	41.4
Health status
Body mass index (kg/m²)
< 25.0	52.8	47.9	56.9
25.0-29.9	31.4	37.5	26.4
≥ 30.0	15.8	14.7	16.7
Health status
Minor psychiatric disorder
No	85.3	92.6	79.5
Yes	14.7	7.5	20.5
Chronic diseases
No	35.9	41.0	31.7
Yes	64.2	59.0	68.3
Self-rated health
Positive	81.2	84.8	78.3
Negative	18.8	15.2	21.7

	Model 1 [OR (95%CI)]	Model 2 [OR (95%CI)]	Model 3 [OR (95%CI)]	Model 4 [OR (95%CI)]	Model 5 [OR (95%CI)]	Model 6 [OR (95%CI)]	Model 7 [OR (95%CI)]
Census tract income
Higher	1.00	1.00	1.00	1.00	1.00	1.00	1.00
Intermediate	1.45 (1.40-1.51)	1.39 (1.33-1.45)	1.52 (1.46-1.59)	1.07 (1.03-1.12)	1.08 (1.03-1.13)	1.00 (0.96-1.05)	1.01 (0.97-1.05)
Lower	2.32 (2.24-2.41)	2.27 (2.19-2.36)	2.41 (2.32-2.51)	1.21 (1.15-1.26)	1.19 (1.14-1.25)	1.11 (1.06-1.15)	1.09 (1.04-1.13)
All neighborhood problems *
Lower		1.00	1.00	1.00	1.00	1.00	1.00
Intermediate		1.30 (1.27-1.34)	1.41 (1.36-1.45)	1.49 (1.44-1.54)	1.54 (1.49-1.59)	1.55 (1.63-1.75)	1.40 (1.35-1.45)
Higher		1.47 (1.43-1.52)	1.56 (1.51-1.61)	1.66 (1.61-1.72)	1.71 (1.65-1.78)	1.69 (1.49-1.60)	1.17 (1.13-1.22)
AIC	165343.6	164750.8	157257.8	146018.5	143306.5	131073.9	118683.5
BIC	165370.8	164797.9	157312.3	146083.6	143380.8	131165.5	118780.2

	Model 1 [OR (95%CI)]	Model 2 [OR (95%CI)]	Model 3 [OR (95%CI)]	Model 1 [OR (95%CI)]	Model 2 [OR (95%CI)]	Model 3 [OR (95%CI)]
Census tract income
Higher	1.00	1.00		1.00	1.00
Intermediate	1.01 (0.97-1.06)	0.97 (0.93-1.01)	0.98 (0.94-1.02)	1.10 (1.05-1.15)	1.02 (0.98-1.06)	1.00 (0.96-1.04)
Lower	1.09 (1.04-1.15)	1.04 (0.99-1.08)	1.05 (1.01-1.09)	1.21 (1.15-1.26)	1.12 (1.07-1.16)	1.07 (1.02-1.12)
Physical problems
Lower	1.00	1.00	1.00
Intermediate	1.87 (1.80-1.93)	1.69 (1.63-1.75)	1.44 (1.39-1.49)
Higher	2.02 (1.95-2.10)	1.81 (1.74-1.88)	1.23 (1.19-1.28)
AIC	14,2610.7	13,0854.2	11,8624.8
BIC	14,2692.0	13,0945.8	11,8721.5
Social disorder problems
Lower				1.00	1.00	1.00
Intermediate				1.09 (1.05-1.13)	1.23 (1.18-1.27)	1.19 (1.15-1.24)
Higher				1.41 (1.37-1.46)	1.43 (1.38-1.48)	1.07 (1.03-1.11)
AIC				14,3869.7	13,1592.4	11,8889.4
BIC				14,3951.0	13,1684.0	11,8986.0

	Males			Females
	Model 1 [OR (95%CI)]	Model 2 [OR (95%CI)]	Model 3 [OR (95%CI)]	Model 1 [OR (95%CI)]	Model 2 [OR (95%CI)]	Model 3 [OR (95%CI)]
Census tract income
Higher	1.00	1.00	1.00	1.00	1.00	1.00
Intermediate	1.21 (1,13-1.28)	1.10 (1.03-1.17)	1.19 (1.11-1.27)	0.92 (0.87-097)	0.90 (0.85-0.95)	0.87 (0.82-0.91)
Lower	1.12 (1.05-1.20)	1.18 (1.01-1.26)	1.20 (1.11-1.28)	1.06 (1.00-1.13)	0.92 (0.87-0.97)	0.95 (0.90-1.00)
Physical problems
Lower	1.00	1.00	1.00	1.00	1.00	1.00
Intermediate	1.62 (1.54-1.72)	1.39 (1.31-1.47)	1.21 (1.14-1.29)	2.00 (1.91-2.10)	1.82 (1.74-1.91)	1.65 (1.57-1.73)
Higher	2.13 (2.02-2.25)	1.77 (1.67-1.87)	1.27 (1.19-1.34)	1.91 (1.82-2.00)	1.81 (1.72-1.90)	1.26 (1.20-1.33)
AIC	54,817.85	51,158.36	47,836.15	86,631.42	78,045.33	68,905.69
BIC	54,882.29	51,231.78	47,913.95	86,699.12	78,122.02	68,986.81

	Males			Females
	Model 1 [OR (95%CI)]	Model 2 [OR (95%CI)]	Model 3 [OR (95%CI)]	Model 1 [OR (95%CI)]	Model 2 [OR (95%CI)]	Model 3 [OR (95%CI)]
Census tract income
Higher	1.00	1.00	1.00	1.00	1.00	1.00
Intermediate	1.36 (1.28-1.45)	1.18 (1.11-1.26)	1.27 (1.19-1.36)	0.97 (0.92-1.03)	0.94 (0.89-0.99)	0.86 (0.82-0.91)
Lower	1.29 (1.21-1.38)	1.29 (1.21-1.38)	1.25 (1.17-1.34)	1.11 (1.05-1.18)	0.96 (0.91-1.01)	0.94 (0.89-0.99)
Social disorder
Lower	1.00	1.00	1.00	1.00	1.00	1.00
Intermediate	1.19 (1.13-1.26)	1.29 (1.22-1.36)	1.10 (1.04-1.17)	1.00 (0.95-1.04)	1.16 (1.10-1.21)	1.31 (1.25-1.38)
Higher	1.04 (0.98-1.10)	1.08 (1.01-1.34)	0.82 (0.77-0.87)	1.67 (1.60-1.74)	1.74 (1.67-1.82)	1.37 (1.31-1.48)
AIC	55531.47	51446.1	47787.2	86928.8	78165.1	69139.17
BIC	55595.87	51519.48	47864.96	86996.51	78241.8	69220.29

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[1] Correspondence D. A. Höfelmann Departamento de Nutrição, Universidade Federaldo Paraná. Av. Prefeito Lothário Meissner 632, Curitiba, PR 80210-170, Brasil. doroteia.hofelmann@ufpr.br