1045 — The Impact of Neighborhood Environment on Veteran Health Status

Nelson KM (VA Puget Sound, University of Washington), Lurie N (RAND), Escarce J (RAND, UCLA), Taylor L (VA Puget Sound), McFarland L (VA Puget Sound), Fihn SD (VA Puget Sound, University of Washington)

Objectives:
Recent advances in social epidemiology have produced a body of literature that suggests, independent of individual socio-demographic factors, neighborhood characteristics influence a broad range of health outcomes. However, there is limited evidence about the association of neighborhood environment with veteran health status. The primary aim of this study is to determine the relative contributions of neighborhood socioeconomic status, health system factors, and individual characteristics to veteran health status.

Methods:
We used data from the Ambulatory Care Quality Improvement Project (ACQUIP), a multi-site, randomized trial of VA primary care patients. Information on personal socioeconcomic indicators, co-morbid disease and Medical Outcomes Study 36-item short form (SF-36), were obtained from baseline enrollment data (n = 12,294). We used the physical component scale (PCS) and mental component scale (MCS) scores to summarize overall physical and mental function. Census tracts were used as proxies for neighborhoods. A summary score was used to characterize the neighborhood socioeconomic (SES) environment. Data were analyzed with multilevel hierarchical models.

Results:
Neighborhood SES was independently associated with both MCS and PCS scores (p < 0.05 for both), controlling for individual socioeconomic status (age, gender, race, education, employment status, income, and service-connected status), self-reported co-morbid disease, depression, smoking status, and health care access (number of outpatient clinic visits, number of inpatient hospitalizations, distance to VA care, and use of non-VA care). In the lowest versus highest quartiles of neighborhood SES, adjusted mean PCS scores were 34.4 and 36.5 (p < 0.001) and adjusted mean MCS scores were 45.5 and 47.9 (p < 0.001). PCS score was also significantly associated with street connectivity, a measure of “walkability” of a neighborhood (p < 0.05).

Implications:
To our knowledge, this project provides the first information about the contributions of neighborhood environment with veteran health status, controlling for health system factors such as access and distance to care, and personal health risks. Veterans living in lower SES neighborhoods have poorer health status, independent of individual characteristics and health care access.

Impacts:
Our findings suggest that a health policy perspective that moves beyond individual and health system characteristics may be useful in identifying factors that will improve veteran health status.