Neighborhood opportunity and mortality among children and adults in their households

Our article in Pediatrics
Natalie Slopen,
Candace Cosgrove,
Mark Hatzenbuehler,
Jack Shonkoff,
Published: 03.28.2023 Updated: 03.28.2023



Research has linked neighborhood opportunity to health outcomes in children and adults; however, few studies have examined neighborhood opportunity and mortality risk among children and their caregivers. The objective of this study was to assess associations of neighborhood opportunity and mortality risk in children and their caregivers over 11 years.


Participants included 1 025 000 children drawn from the Mortality Disparities in American Communities study, a cohort developed by linking the 2008 American Community Survey to the National Death Index and followed for 11 years. Neighborhood opportunity was measured using the Child Opportunity Index, a measure designed to capture compounding inequities in access to opportunities for health.


Using hazard models, we observed inverse associations between Child Opportunity Index quintile and deaths among child and caregivers. Children in very low opportunity neighborhoods at baseline had 1.30 times the risk of dying over follow-up relative to those in very high opportunity neighborhoods (95% confidence interval [CI], 1.15–1.45), and this excess risk attenuated after adjustment for household characteristics (hazard ratio, 1.15; 95% CI, 0.98–1.34). Similarly, children in very low opportunity neighborhoods had 1.57 times the risk of experiencing the death of a caregiver relative to those in very high opportunity neighborhoods (95% CI, 1.50–1.64), which remained after adjustment (hazard ratio, 1.30; 95% CI, 1.23–1.38).


Our analyses advance understanding of the adverse consequences of inequitable neighborhood contexts for child well-being and underscore the potential importance of place-based policies for reducing disparities in child and caregiver mortality.

Headshot of Dolores Acevedo-Garcia
Dolores Acevedo-Garcia
Director, Professor of Human Development and Social Policy
Clemens Noelke
Clemens Noelke
Research Director