Neighborhoods and health: where are we and were do we go from here?

Abstract

SummaryIn recent years there has been an explosion of interest in neighborhood health effects. Most existing work has relied on secondary data analyses and has used administrative areas and aggregate census data to characterize neighborhoods. Important questions remain regarding whether the associations reported by these studies reflect causal processes. This paper reviews the major limitations of existing work and discusses areas for future development including (1) definition and measurement of area or ecologic attributes (2) consideration of spatial scale (3) cumulative exposures and lagged effects and (4) the complementary nature of observational, quasi-experimental, and experimental evidence. As is usually the case with complex research questions, consensus regarding the presence and magnitude of neighborhood health effects will emerge from the work of multiple disciplines, often with diverse methodological approaches, each with its strengths and its limitations. Partnership across disciplines, as well as among health researchers, communities, urban planners, and policy experts will be key.

Is cognitive decline in the elderly associated with contextual income? Results of a population-based study in southern Brazil

“…This limitation has been observed in multilevel epidemiological studies, largely due to the availability of data provided by national surveys, which often do not represent the ideal area for investigating health outcomes 45 . The definition of a neighborhood, its spatial delimitation and the choice of variables that best relate to the outcome, make use of fairly challenging contextual measures for observational studies, and should therefore be considered with caution in their analysis 46 .…”

Functional performance and social relations among the elderly in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil: a population-based epidemiological study

“…Another limitation relates to the breadth of the question on satisfaction with personal relations, preventing separate assessment of satisfaction in relations with various relatives and friends, as well as with social activities and intimacy 33 or material, instrumen-tal, and emotional support, information, and positive interaction 32 . It is also not possible to rule out a same-source bias, that is, the exclusive use of self-reported variables to measure both functional performance and social relations 34 . This bias is difficult to eliminate, since the quality of social relations is by definition a subjective evaluation.…”

Aging and Urbanization: The Neighborhood Perception and Functional Performance of Elderly Persons in Belo Horizonte Metropolitan Area—Brazil

“…37,38 Same-source bias is another limitation, that is, the possibility that the use of self-reported data for both the outcome and the neighborhood characteristic generates a spurious association between the two because the measurement error in both reports is correlated or because the outcome affects the perception or report of the neighborhood attribute. 39 …”