Aging in Place and Residential Segregation: An Analysis of Health and Well-Being Inequities

Background/Purpose: Scholars have documented how racialized residential segregation in the United States arose from a series of specific Federal policy decisions including mortgage regulations, the location of public housing, and enforcement of fair housing law. A newer body of literature proposes that segregation harms health by creating physical and socioeconomic contexts that deepen existing inequities. Recent research links living in highly-segregated neighborhoods with deleterious health outcomes, however few studies have examined the influence of racial segregation on the health and well-being of older adults. This study aims to investigate the association between segregation and health and well-being among older adults, including the potential moderating role of race and poverty. 

Method: This study used longitudinal data sources and a quasi-experimental design. Survey data came from the first four waves (2011-2014) of National Health and Aging Trends Study (NHATS), a representative sample of Medicare beneficiaries ages 65 and older in the U.S.. The NHATS sample was age-stratified, with individuals selected from 5-year age groups between the ages of 65 and 90, and from individuals age 90 and older.  Our study sample included 3,955 community-dwelling older adults who: 1) did not move, 2) live in a Core Based Statistical Area (i.e., cities and suburbs), and 3) completed an interview across all four waves of data collection. Combining NHATS data with census tract data from the Neighborhood Change Database, we estimated endogenous treatment effects of living in a hyper-segregated county on self-rated health and subjective well-being, conditioning on individual- and census tract-level covariates. Our binary treatment variable is living in a hyper-segregated county (i.e., has both an uneven racial population distribution and isolated racialized neighborhoods). Additionally, we tested the potential moderating roles of race and Medicaid receipt (as an indicator of poverty status).

Results: Race significantly moderates the effect of hyper-segregation on self-rated health (F_(3,54)= 3.22, p < .05) and subjective well-being (F_(3,54)= 5.31, p < .01); however Medicaid receipt is not a significant moderator. African-American respondents in a hypersegregated county report lower self-rated health than Whites in a non-hypersegregated county, all things equal (B = -.38, p < .01). Similarly, African-Americans living in hypersegregated counties report lower subjective well-being than Whites in non-hypersegregated counties (B = -1.67, p < .001), and individuals of other races (besides African-American, White, or Hispanic) report lower well-being than Whites in non-hypersegregated counties (B = -1.65, p < .05). In other words, White respondents are better off in hyper-segregated counties, compared to respondents who are Black or of other races.

Implications: This study adds to the growing literature on the effects of segregation on older adults’ health and well-being. Contrary to prior research, we did not find that poverty moderated these relationships. However, White older adults appear to benefit from segregation in ways African-Americans and other minority races do not. Our findings support policies that promote fair housing enforcement policies, and call attention to a more nuanced view of aging in place as a way to optimize older adults’ health and well-being.