Community Subcultural Orientation and Mortality following Life-Threatening Diseases in Older Life

Ming Wen, University of Utah
Nicholas Christakis, Harvard Medical School

This paper reports the results from a multilevel study on the prospective effects of community subcultural orientation on mortality following onset of thirteen life-threatening diseases in later life. The study also examined the inter-relationship among community economic, physical, social, and subcultural effects on the survival chances of elderly patients. Three data sources were used to construct the working sample in this study: the 1990 Census, the 1994-95 PHDCN-CS, and the COSI data. 51 ZIP code areas and 12,672 elderly patients were studied. We find that a measure of anomie at the community level significantly predicts higher rates of mortality for older patients with serious diseases over and above personal characteristics (OR=1.26). The data also show that subcultural orientation, in addition to social and structural contexts, is important to health in its own right. Moreover, beliefs and attitudes as measured by anomie can partially explain the link between other community factors and health, and vice versa.