Longer Residence in Disadvantaged Neighborhoods Predicts Both a Syndrome of Despair and Deaths of Despair: Complementary Evidence From Nationwide Register and Birth-Cohort Studies

Abstract

Deaths of despair have been difficult to predict by focusing solely on individual-level factors. In two complementary studies, we tested whether individuals living in disadvantaged neighborhoods in a country with robust social safety nets (New Zealand) were at greater risk for a despair-related death (suicides, drug overdoses, alcohol poisonings, and liver disease, Study 1) or a “premorbid” midlife syndrome of despair-related maladies (suicidality, substance misuse, sleep problems, and chronic pain, Study 2). In 2 decades of observation, New Zealanders residing in disadvantaged neighborhoods across adulthood were at greater risk for a despair-related death ( N = 2.4 million; analytic sample using nationwide administrative data, population risk ratio per quintile increase in cumulative disadvantage = 1.27, 95% confidence interval [CI] = 1.23, 1.30) and a more severe premorbid syndrome of despair-related maladies ( N = 907; analytic sample using a population-representative birth cohort, β = 0.24, 95% CI = 0.17, 0.31). Findings held after adjustment for individual-level socioeconomic status and in Study 2, adjustment for childhood antecedents and adult difficulties that could provoke despair. Neighborhoods could be intervention targets to reduce despair-related deaths.