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Marginal Structural Modeling: Towards Recovering Casual Estimates of Neighborhood Poverty and Mortality

a PSC Research Project

Investigators:   Michael R. Elliott, Ana Diez Roux, Hal Morgenstern

The disparities in the distribution of goods and services, and hazards and opportunities across space are increasing, underscoring the growing connection between place and health. Although ample evidence confirms that living in an economically disadvantaged neighborhood is associated with adverse health outcomes, the reliance on cross-sectional data and inadequate attention to two main sources of bias make causal inferences problematic. Residents tend to sort themselves into different types of neighborhoods based on a multitude of characteristics. Not accounting for all characteristics that are correlated to both the outcome and neighborhood context would likely lead to over-estimations of neighborhood effects. Because regression models cannot possibly account for all relevant factors, the strong possibility of unobserved heterogeneity make neighborhood effect studies open to criticisms of omitted variable bias. Yet, at the same time, neighborhood effect studies are also just as likely to be susceptible to bias due to overadjustment.

Many factors that are controlled for in neighborhood effect models, such as educational attainment, income, and employment, may arguably have been influenced by past neighborhood context. Adjusting for these factors eliminate possible critical pathways through which neighborhoods affect health, likely yielding overly conservative estimates of neighborhood effects. These two sources of bias, working in opposing directions, have plagued extant neighborhood-health research; consequently, results from current research yield tenuous and ambiguous inferences. This proposed project will use novel analytical methods and longitudinal data from an existing observational study to address the two major limitations described above and recover causal estimates of neighborhood poverty on self-rated health and mortality. We

will 1) use marginal structural modeling to appropriately adjust for covariates that are simultaneously confounders as well as mediators and 2) conduct a sensitivity analysis to determine the robustness of the neighborhood effect findings to unobserved heterogeneity. Applying this combined methodology to neighborhood-health research has the potential to significantly advance our knowledge of the relationship between place and health, yielding far reaching policy implications.

Funding Period: 09/30/2009 to 08/31/2011

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