A Longitudinal Ecologic Analysis of Neighborhood-Level Social Inequalities in Health in Texas

Most health studies use cross-sectional data to examine neighborhood context because of the difficulty of collecting and analyzing longitudinal data; this prevents an examination of historical trends that may influence health outcomes. Using the Neighborhood Change Database, we categorized longitudinal (1990-2010) poverty and White concentration trajectories (long-term low, long-term moderate, long-term high, increasing, or decreasing) for Texas census tracts and linked them to tract-level health-related characteristics (social determinants of health [SDOH] in 2010, health risk and preventive behaviors [HRPB] in 2017, and health status/outcomes [HSO] in 2017) from multiple sources (N = 2961 tracts). We conducted univariate and bivariate descriptive analyses, followed by linear regressions adjusted for population density. SDOH, HRPB, and HSO measures varied widely across census tracts. Both poverty and White concentration trajectories were strongly and consistently associated with a wide range of SDOH. Long-term high-poverty and low-White tracts showed the greatest disadvantages, while long-term low-poverty and high-White tracts had the most advantages. Neighborhoods undergoing changes in poverty or White concentrations, either increasing or decreasing, had less advantageous SDOH compared with long-term low-poverty or long-term high-White neighborhoods. While associations between poverty, White concentration trajectories, and SDOH were consistent, those with HRPB and HSO were less so. Understanding impact of the relationships between longitudinal neighborhood poverty and racial/ethnic composition on health can benefit stakeholders designing policy proposals and intervention strategies.