Diminished Returns of Neighborhood Cohesion for Self-rated Health Across Racial and Ethnic Groups Among Working-age Adults in the United States.

backgroundHigher neighborhood social cohesion is associated with better self-rated health (SRH), but few studies have examined whether this association differs across racial and ethnic groups, leaving open the possibility that its health benefits are not shared equally.

methodsData were drawn from the 2013 to 2018 National Health Interview Survey (N = 117,126 adults aged 25 to 65). Survey-weighted logistic regression models estimated the association between perceived neighborhood cohesion and poor SRH, with interaction and stratified models testing whether the association varied by race and ethnicity. All models adjusted for sociodemographic, behavioral, and geographic covariates.

resultsHigher neighborhood cohesion was associated with lower odds of poor SRH (OR = 0.94, 95% CI: 0.93 to 0.95). This protective association was not shared equally across racial and ethnic groups (race by cohesion interaction p < 0.001). The association was weaker for Hispanic adults (OR = 0.96, 95% CI: 0.94 to 0.97) and non-Hispanic Black adults (OR = 0.96, 95% CI: 0.95 to 0.98) than for non-Hispanic White adults (OR = 0.93, 95% CI: 0.92 to 0.94), and this differential was robust across multiple sensitivity analyses.

conclusionThe health benefits of neighborhood cohesion are not uniform across racial and ethnic groups. These findings extend the minorities' diminished returns framework to a contextual social resource and suggest that strengthening social ties alone is unlikely to close health gaps without accompanying investments in the material and institutional conditions that shape how cohesion translates into health.