Neighborhood disadvantage, individual-level socioeconomic position and physical function: A cross-sectional multilevel analysis

Introduction. Understanding associations between physical function and neighborhood disadvantage may provide insights into which interventions might best contribute to reducing socioeconomic inequalities in health. This study examines associations between neighborhood-disadvantage, individual-level socioeconomic position (SEP) and physical function from a multilevel perspective. Methods. Data were obtained from the HABITAT multilevel longitudinal (2007-13) study of middle-aged adults, using data from the fourth wave (2013). This investigation included 6004 residents (age 46-71 years) of 535 neighborhoods in Brisbane, Australia. Physical function was measured using the PF-10 (0-100), with higher scores indicating better function. The data were analyzed using multilevel linear regression and were extended to test for cross-level interactions by including interaction terms for different combinations of SEP (education, occupation, household income) and neighborhood disadvantage on physical function. Results. Residents of the most disadvantaged neighborhoods reported significantly lower physical function (men: beta-11.36 95% CI-13.74,-8.99; women: beta-11.41 95% CI-13.60,-9.22). These associations remained after adjustment for individual-level SEP. Individuals with no post-school education, those permanently unable to work, and members of the lowest household income had significantly poorer physical function. Cross-level interactions suggested that the relationship between household income and physical function is different across levels of neighborhood disadvantage for men; and for education and occupation for women. Conclusion. Living in a disadvantaged neighborhood was negatively associated with physical function after adjustment for individual-level SEP. These results may assist in the development of policy-relevant targeted interventions to delay the rate of physical function decline at a community-level. (C) 2016 Elsevier Inc. All rights reserved.