Association for Public Policy Analysis & Management

Urban policy 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 the majority of studies have examined outcomes among children and adults. Less is known about the association between segregation and 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 Medicaid receipt (e.g., those in poverty).

This study used longitudinal data sources and a quasi-experimental design. Survey data came from the first four waves (2011-2014) of NHATS, a panel study sponsored by the National Institute on Aging. 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. The first wave in 2011 contains data on 8,245 older adults and had a response rate of 70.9%. For our study, we restricted the sample to 1) community-dwelling respondents, 2) who did not move, 3) live in a Core Based Statistical Area, and 4) completed an interview across all four waves of data collection. 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. Additionally, we tested the potential moderating roles of race and Medicaid receipt.

Race significantly moderates the effect of 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. In our first set of models, the effect of hyper-segregation on self-rated health is smaller for Black respondents compared to White respondents (B = -.38, p < .01). Similarly, the effect of hyper-segregation on subjective well-being is smaller for Black respondents compared to White respondents (B = -1.67, p < .001) and respondents of races other than Black, White, or Hispanic (B = -1.65, p < .05). In other words, being White buffers the effect of living in a hyper-segregated area on self-rated health and subjective well-being compared to being Black or other races.

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, as evinced by Medicaid receipt, moderated these relationships. Consistent with previous studies, we found that older adults in segregated places had poorer health. However, Black older adults and older adults of “other” races appear to have been protected from segregation while White older adults were not. Our findings support fair housing enforcement policies and aging in place as a way to optimize older adults’ health and well-being.