Neighborhood Child Opportunity and Life Expectancy in the United States

Background:

Background: Neighborhood poverty is associated with negative health outcomes in children. Limited neighborhood resources and deleterious physical conditions are a manifestation of community poverty and may explain the relationship between neighborhood poverty and poor child health. The objective of this study was to evaluate the association of neighborhood opportunity for children and life expectancy at birth in the US.

Methods: This is a cross-sectional study. The primary outcome is life expectancy at birth at the census tract level, defined by the US Small-area Life Expectancy Estimates Project using mortality data from 2010-2015. The exposure is the neighborhood conditions for children in 2015, quantified by the Child Opportunity Index 2.0 score for the census tract. This index captures community conditions and resources that influence child health and long-term outcomes. It includes 29 weighted indicators of neighborhood conditions and classifies the indicators into 3 domains: education, health and environment, and social and economic.

We used linear regression models to estimate the association of the Child Opportunity Index score and life expectancy at birth at the census-tract level. Model one included the overall Child Opportunity Index score, model two included the domain-specific Child Opportunity Index scores. Census tracts were divided into five groups, each with 20% of the child population based on Child Opportunity Index scores: very low opportunity, low opportunity, moderate opportunity, high opportunity, and very-high opportunity. The models used robust standard errors clustered on county.

Results: We included 65,662 census tracts (90% of US). The mean life expectancy at birth was 78.2 years (SD 4.0 years, range 56.3 to 93.6 years). The linear regression models are summarized in table 1. Life expectancy in census tracts with overall very low opportunity for children was lower than in census tracts with overall very high opportunity for children by 7.54 years (95% CI 7.17-7.92; figure 1). For each domain the life expectancy was lowest in the very lower opportunity areas: education 2.69 years (95%CI 2.21-3.10), health and environment 2.96 years (95% CI 2.32-3.60), social and economic 3.50 years (95%CI 3.01-4.01). The models accounted for 41-44% of the variability in life expectancy at birth. We observed a step-wise relationship between overall and domain-specific Child Opportunity Index categories and life expectancy at birth.

Conclusion: Neighborhood opportunity for children is strongly associated with life expectancy at birth, accounting for over 40% of variability in life expectancy at the census tract level. Census tracts with very low opportunity for children have a life expectancy of 7.5 years less than census tracts with very high opportunity for children. Community conditions and resources are critical targets for anti-poverty interventions and policies to improve life expectancy, which may address inequities in life expectancy across populations in the US.