Neighborhood environment and self-reported health status: a multilevel analysis.

OBJECTIVES: This study examined whether neighborhood socioeconomic environment helps to explain the proportion of community members with self-reported poor health status. METHODS: A random sample of 9240 persons aged 25 to 74 years were interviewed during 1988 and 1989. The socioeconomic environment of each respondent's neighborhood was measured with the Care Need Index (CNI) and the Townsend score. The data were analyzed with a multilevel model adjusted for the independent variables. The second-level variables were the 2 neighborhood scores. RESULTS: There was a clear gradient for poor health and education within every CNI interval so that with an increasing CNI (indicating more deprivation), the prevalence of poor health increased in all 3 education groups (P = .001). In the full model, decreasing educational level, obesity, length and frequency of smoking, physical inactivity, and increasing CNI were associated with poor health. Persons living in the most deprived neighborhoods had a prevalence ratio of 1.69 (95% confidence interval = 1.44, 1.98) for poor health compared with those living in the most affluent areas. CONCLUSIONS: Both neighborhood socioeconomic environment and individual educational status are associated with self-reported poor health.