Racial disparities in self-rated health at older ages: What difference does the neighborhood make?

Objectives. Racial differences in self-rated health at older ages are well documented. African Americans consistently report poorer health, even when education, income, and other health status indicators are controlled. The extent to which neighborhood-level characteristics mediate this association remains largely unexplored. We ask whether neighborhood social and economic resources help to explain the self-reported health differential between African Americans and Whites. Methods. Using the 1990 Decennial Census, the 1994-1995 Project on Human Development in Chicago Neighborhoods-Community Survey, and selected years of the 1991-2000 Metropolitan Chicago Information Center-Metro Survey, we examine the impact of neighborhood structure and social organization on self-rated health for a sample of Chicago residents aged 55 and older (N=636). We use multilevel modeling techniques to examine both individual and neighborhood-level covariates. Results. Findings indicate that affluence, a neighborhood structural resource, contributes positively to self-rated health and attenuates the association between race and self-rated health. When the level of affluence in a community is low, residential stability is negatively related to health. Collective efficacy, a measure of neighborhood social resources, is not associated with health for this older population. Discussion. Analyses incorporating individual and neighborhood-level contextual indicators may further our understanding of the complex association between sociodemographic factors and health.