Tinka Markham Piper, MPH, CSW¹, Sandro Galea, MD, MPH, DrPH¹, Melissa Tracy, BA¹, Jennifer Ahern, MPH¹, Kenneth J. Tardiff, MD, MPH², and David Vlahov, PhD¹. (1) Center for Urban Epidemiologic Studies, New York Academy of Medicine, 1216 Fifth Avenue, New York, NY 10029, 212-419-3584, kmarkham@nyam.org, (2) Department of Psychiatry, New York Presbyterian Hosptial, 525 East 68th Street Box 140, New York, NY 10021

Several characteristics of the neighborhood environment have been associated with morbidity and mortality. Few studies have considered differences in the relation between neighborhood conditions and different (intentional and unintentional) fatal injuries. We collected data from the New York City (NYC) Office of the Chief Medical Examiner for all fatal injuries in 1996 to conduct multilevel case control studies using accidental overdose deaths (n=725), homicides (n=793) and suicides (n=374) as cases, with non-overdose accidental deaths (n=453) as controls. We used 1990 US Census data to determine neighborhood income distribution in NYC, and data from the 1999 NYC Housing and Vacancy Survey and the Mayor’s Office of Operations to assess characteristics of the neighborhood internal and external built environment. Both neighborhood income inequality and poorer characteristics of the external (e.g. buildings in dilapidated condition and lack of acceptably clean streets) and internal (e.g. toilet and heat breakdowns) physical environment were significantly associated with greater likelihood of overdose deaths. While income inequality was significantly associated with increased risk of suicide, characteristics of the neighborhood physical environment were not. Neither neighborhood income distribution nor physical conditions were associated with homicide risk. These results demonstrate the varying roles played by features of the neighborhood environment in determining individual risk for different forms of fatal injury. A better understanding of relevant neighborhood characteristics and the mechanisms through which they influence different health outcomes is needed for targeted public health interventions.

Learning Objectives:

• 1. To describe the prevalence of homicide, suicide, drug overdose deaths and non-overdose accidental deaths in New York City in 1996
• 2. To articulate the procedure for identifying measurable characteristics of income distribution and the internal and external built environment
• 3. To identify the varying roles played by features of the neighborhood environment to determine individual risk for different forms of fatal injury

Keywords: Death, Environment

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.