The Association of Neighborhood Changes with Health-Related Quality of Life in the Women’s Health Initiative

Abstract

Longitudinal studies can help us understand the effects of long-term neighborhood changes, as these can capture individual self-appraisal of current and future circumstances. We analyzed the association between neighborhood changes and health-related quality of life (HRQoL) outcomes among older women from the Women’s Health Initiative (WHI) study. We used a subset (n = 49,254) of the longitudinal WHI dataset of female participants, aged 50–79 at baseline, recruited from 40 clinical centers across the U.S. beginning in 1993. Two HRQoL outcomes were explored: self-rated quality of life (SRQoL), and physical functioning-related quality of life (PFQoL). We used U.S. census tract-level changes in median household income between the 2000 census and 2007–2011 American Community Survey to classify neighborhoods as “upgrading,” “declining,” or “stable.” Multi-level models were used to identify significant associations between neighborhood change and HRQoL outcomes over time. Compared to participants residing in upgrading neighborhoods, participants in stable and declining neighborhoods reported significantly lower PFQoL. A significant interaction was observed with income such that the effect of neighborhood change was greater at lower levels of income.