摘要：Objectives. We sought to determine whether the association between neighborhood characteristics and health differs for people with and without a chronic condition. Methods. We analyzed data from 2536 adults from the Los Angeles Family and Neighborhood Survey and evaluated the relationship between the presence of a chronic condition at the individual level, neighborhood socioeconomic status (SES), and self-rated health. We constructed multilevel models to evaluate the relationship between the neighborhood SES index and self-rated health for people with and without chronic conditions, after adjustment for other individual characteristics. Results. Having a chronic condition was associated with substantially poorer self-rated health among participants in a deprived area than among those in a more advantaged area. Conclusions. Residence in a disadvantaged neighborhood may be associated with barriers to the management of a chronic condition. Further work is needed to identify the specific characteristics of disadvantaged areas associated with poorer self-rated health for adults with chronic conditions. Residence in a socioeconomically deprived neighborhood has been linked to all-cause mortality, 1 – 3 functional decline, 4 poorer health status, 5 , 6 and higher incidence and prevalence of chronic conditions such as diabetes, cardiovascular disease, and cancer. 2 , 7 – 16 People living in deprived neighborhoods are likely to experience multiple dimensions of poor environmental and social quality, including higher-priced yet lower-quality foods, high crime rates, poor-quality housing, limited transportation, toxic environments, and lower social cohesion and social support, all of which may contribute to poorer health. 13 , 17 – 22 Adults with chronic conditions may be particularly vulnerable to these dimensions of neighborhood deprivation. Models of chronic disease management, such as the Chronic Care Model 23 – 25 and the Disablement Framework, 26 highlight the importance of community resources to the management of chronic conditions. Yet research on chronic conditions tends to emphasize clinical care, the health care system, and individual factors, and only infrequently examines the role of the neighborhood environment in the management of chronic disease. There are, however, several mechanisms through which the neighborhood context may differentially affect the health of people with chronic conditions. Among adults with conditions such as diabetes, cardiovascular disease, arthritis, and asthma, adequate disease management often requires continuous clinical follow-up, self-care, and complex medication, dietary, and exercise regimens, 24 all of which may be influenced by neighborhood factors such as available health care, access to exercise facilities and nutritious foods, and environments otherwise conducive to self-management. Thus, the characteristics of local areas, such as limited availability or accessibility of health services, infrastructure deprivation, environmental stressors, and social interactions that promote an unhealthy lifestyle 19 , 20 , 27 may be associated with greater reductions in health status among adults with chronic conditions than among those without a chronic condition. We conducted a cross-sectional analysis of the 2000–2001 Los Angeles Family and Neighborhood Survey (LAFANS) to examine whether the neighborhood socioeconomic environment contributes to differences in self-rated health among persons with and without a chronic condition. We chose to evaluate self-rated health because it is closely associated with several health outcomes, including morbidity 28 , 29 and mortality, 30 , 31 and determinants of health ratings have been shown to differ between people with and without chronic conditions. 32 – 34 We hypothesized that, independent of individual income or education, lower neighborhood socioeconomic status would be associated with lower self-rated health and that the association would be strongest for persons with a chronic condition.
