a b s t r a c tNeighborhood social capital is increasingly considered to be an important determinant of an individual's health. Using data from the Netherlands we investigate the influence of neighborhood social capital on an individual's self-reported health, while accounting for other conditions of health on both the level of the neighborhood and the individual. We use national representative data ('The Housing and Living Survey', 2006) on the Netherlands with 61,235 respondents in 3273 neighborhoods. The cross-sectional data were combined with information provided by Statistics Netherlands on neighborhoods, i.e., the percentage of residents in the highest income quintile per neighborhood and the municipality's degree of urbanity. The association of neighborhood social capital with individual health was assessed by multilevel logistic regression analysis. Our results show that neighborhood social capital is positively associated with health. Interestingly, residents in urban neighborhoods benefit particularly from their neighborhood social capital.

BackgroundAlthough various studies have found a positive association between neighborhood social capital and individual health, the mechanism explaining this direct effect is still unclear. Neighborhood social capital is the access to resources that are generated by relationships between people in a friendly, well-connected and tightly knit neighborhood community. We expect that the resources generated by cohesive neighborhoods support and influence health -improving behaviors in daily life. We identify five different health-related behaviors that are likely to be affected by neighborhood social capital and test these behaviors separately as mediators.MethodsThe data set pertaining to individual health was taken from the 'health interview' in the 'Second Dutch national survey of general practice' (DNSGP-2, 2002). We combine these individual-level data with data from the 'Dutch housing demand survey' (WBO, 1998 and WoON, 2002) and statistical register information (1995-1999). Per neighborhood 29 WBO respondents, on average, had answered questions regarding social capital in their neighborhood. These variables have been aggregated to the neighborhood level by an ecometric methodology. In the main analysis, in which we tested the mediation, multilevel (ordered) logistic regressions were used to analyze 9253 adults (from the DNSGP-2 data set) from 672 Dutch neighborhoods. In the Netherlands, on average, neighborhoods (4-digit postcodes) comprise 4,000 inhabitants at highly variable population densities. Individual- and neighborhood-level controls have been taken into account in the analyses.ResultsIn neighborhoods with a high level of social capital, people are more physically active and more likely to be non-smokers. These behaviors have positive effects on their health. The direct effect of neighborhood social capital on health is significantly and strongly reduced by physical activity. This study does not support nutrition and sleep habits or moderate alcohol intake as possible explanations of the effects of neighborhoods on health.ConclusionsThis study is one of the first to test a mechanism explaining much of the direct effect of small-area social capital on individual health. Neighborhood interventions might be most successful at improving health if they stimulate both social interaction and physical activity.

The present study investigating 31 physical diseases is the most extensive analysis to date on the topic of back pain and comorbidity. This is an attempt to cast light on the tangled relationships involved in developing and coping with back pain. In view of the large percentage of unspecific back pain, we believe it is important for physicians treating back pain to extend their history and diagnostic analysis skills to embrace comorbidities related to the back pain.

Background The aim of this study is to present average annual healthcare costs for Dutch renal replacement therapy (RRT) patients for 7 treatment modalities. Methods Health insurance claims data from 2012–2014 were used. All patients with a 2014 claim for dialysis or kidney transplantation were selected. The RRT related and RRT unrelated average annual healthcare costs were analysed for 5 dialysis modalities (in-centre haemodialysis (CHD), home haemodialysis (HHD), continuous ambulatory peritoneal dialysis (CAPD), automated peritoneal dialysis (APD) and multiple dialysis modalities in a year (Mix group)) and 2 transplant modalities (kidney from living and deceased donor, respectively). Results The total average annual healthcare costs in 2014 ranged from €77,566 (SD = €27,237) for CAPD patients to €105,833 (SD = €30,239) for patients in the Mix group. For all dialysis modalities, the vast majority (72–84%) of costs was RRT related. Patients on haemodialysis ≥4x/week had significantly higher average annual costs compared to those dialyzing 3x/week (Δ€19,122). Costs for kidney transplant recipients were €85,127 (SD = €39,679) in the year of transplantation and rapidly declined in the first and second year after successful transplantation (resp. €29,612 (SD = €34,099) and €15,018 (SD = €16,186)). Transplantation with a deceased donor kidney resulted in higher costs (€99,450, SD = €36,036)) in the year of transplantation compared to a living donor kidney transplantation (€73,376, SD = €38,666). Conclusions CAPD patients have the lowest costs compared to other dialysis modalities. Costs in the year of transplantation are 25% lower for patients with kidneys from living vs. deceased donor. After successful transplantation, annual costs decline substantially to a level that is approximately 14–19% of annual dialysis costs.