Associations of perceived neighborhood environment on health status outcomes in persons with arthritis

Authors

  • Kathryn Remmes Martin,

    1. University of North Carolina at Chapel Hill
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  • Jack Shreffler,

    1. University of North Carolina at Chapel Hill
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    • Dr. Shreffler has received consultancy fees, speaking fees, and/or honoraria (less than $10,000) from the NIH Patient-Reported Outcomes Measurement Information System Assessment Center Usability Meeting.

  • Britta Schoster,

    1. University of North Carolina at Chapel Hill
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  • Leigh F. Callahan

    Corresponding author
    1. University of North Carolina at Chapel Hill
    • 3300 Thurston Building CB #7280, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
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    • Dr. Callahan has received consultancy fees, speaking fees, and/or honoraria (less than $10,000 each) from the NIH, the Canadian Arthritis Network, the University of Washington Pain Behaviors Study, and the National Association of Chronic Disease Directors.


Abstract

Objective

To examine the association between 4 aspects of perceived neighborhood environment (aesthetics, walkability, safety, and social cohesion) and health status outcomes in a cohort of North Carolinians with self-reported arthritis after adjustment for individual and neighborhood socioeconomic status covariates.

Methods

In a telephone survey, 696 participants self-reported ≥1 types of arthritis or rheumatic conditions. Outcomes measured were physical and mental functioning (Short Form 12 health survey version 2 physical component and mental component summary [MCS]), functional disability (Health Assessment Questionnaire), and depressive symptomatology (Center for Epidemiologic Studies Depression Scale scores <16 versus ≥16). Multivariate regression and multivariate logistic regression analyses were conducted using Stata, version 11.

Results

Results from separate adjusted models indicated that measures of associations for perceived neighborhood characteristics were statistically significant (P ≤ 0.001 to P = 0.017) for each health status outcome (except walkability and MCS) after adjusting for covariates. Final adjusted models included all 4 perceived neighborhood characteristics simultaneously. A 1-point increase in perceiving worse neighborhood aesthetics predicted lower mental health (B = −1.81, P = 0.034). Individuals had increased odds of depressive symptoms if they perceived lower neighborhood safety (odds ratio [OR] 1.36, 95% confidence interval [95% CI] 1.04–1.78; P = 0.023) and lower neighborhood social cohesion (OR 1.42, 95% CI 1.03–1.96; P = 0.030).

Conclusion

Study findings indicate that an individual's perception of neighborhood environment characteristics, especially aesthetics, safety, and social cohesion, is predictive of health outcomes among adults with self-reported arthritis, even after adjusting for key variables. Future studies interested in examining the role that community characteristics play on disability and mental health in individuals with arthritis might consider further examination of perceived neighborhood environment.

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