How segregation, low birth weight, unemployment, and violence link to low life expectancy in Chicago.

Introduction: Life expectancy gaps between downtown Chicago and communities on the west and south approach 25 years. Multiple social factors relate to this gap, but identifying which are "difference-makers" is challenging. Methods: Using data from the Chicago Health Atlas, we analyzed 34 social factors using a configurational approach to identify the minimum set of factors necessary and sufficient for low life expectancy across Chicago's 77 community areas. Results: We identified 3 factors-high rates of low birth weight, high unemployment, and high non-fatal shootings-that were directly linked to low life expectancy across 3 pathways: (1) high rates of low birth weight AND high unemployment OR (2) high non-fatal shootings AND high rates of low birth weight OR (3) high non-fatal shootings AND high unemployment. We then explored whether high residential segregation was an antecedent to these pathways, and found that it directly linked to high rates of low birth weight, which, when combined with high unemployment and high non-fatal shootings, linked to low life expectancy. Conclusion: Understanding how the interplay of social factors contributes to the complex phenomenon of low life expectancy can help policymakers add precision and nuance to public health efforts to close life expectancy gaps.