{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T17:56:11Z","timestamp":1792086971016,"version":"4.4.0"},"reference-count":58,"publisher":"Wiley","issue":"S2","license":[{"start":{"date-parts":[[2020,8,29]],"date-time":"2020-08-29T00:00:00Z","timestamp":1598659200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To examine mediation and moderation of racial\/ethnic all\u2010cause mortality disparities among Veteran Health Administration (VHA)\u2010users by neighborhood deprivation and residential segregation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data sources<\/jats:title><jats:p>Electronic medical records for 10\/2008\u20109\/2009 VHA\u2010users linked to National Death Index, 2000 Area Deprivation Index, and 2006\u20102009 US Census.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study design<\/jats:title><jats:p>Racial\/ethnic groups included American Indian\/Alaskan Native (AI\/AN), Asian, non\u2010Hispanic black, Hispanic, Native Hawaiian\/Other Pacific Islander, and non\u2010Hispanic white (reference). We measured neighborhood deprivation by Area Deprivation Index, calculated segregation for non\u2010Hispanic black, Hispanic, and AI\/AN using the Isolation Index, evaluated mediation using inverse odds\u2010weighted Cox regression models and moderation using Cox regression models testing for neighborhood*race\/ethnicity interactions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Principal findings<\/jats:title><jats:p>Mortality disparities existed for AI\/ANs (HR\u00a0=\u00a01.07, 95%CI:1.01\u20101.10) but no other groups after covariate adjustment. Neighborhood deprivation and Hispanic segregation neither mediated nor moderated AI\/AN disparities. Non\u2010Hispanic black segregation both mediated and moderated AI\/AN disparities. The AI\/AN vs. non\u2010Hispanic white disparity was attenuated for AI\/ANs living in neighborhoods with greater non\u2010Hispanic black segregation (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.047). Black segregation's mediating effect was limited to VHA\u2010users living in counties with low black segregation. AI\/AN segregation also mediated AI\/AN mortality disparities in counties that included or were near AI\/AN reservations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Neighborhood characteristics, particularly black and AI\/AN residential segregation, may contribute to AI\/AN mortality disparities among VHA\u2010users, particularly in communities that were rural, had greater black segregation, or were located on or near AI\/AN reservations. This suggests the importance of neighborhood social determinants of health on racial\/ethnic mortality disparities. Living near reservations may allow AI\/AN VHA\u2010users to maintain cultural and tribal ties, while also providing them with access to economic and other resources. Future research should explore the experiences of AI\/ANs living in black communities and underlying mechanisms to identify targets for intervention.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1475-6773.13547","type":"journal-article","created":{"date-parts":[[2020,8,29]],"date-time":"2020-08-29T08:21:49Z","timestamp":1598689309000},"page":"851-862","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Relationship of neighborhood social determinants of health on racial\/ethnic mortality disparities in US veterans\u2014Mediation and moderating effects"],"prefix":"10.1111","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7917-9696","authenticated-orcid":false,"given":"Michelle S.","family":"Wong","sequence":"first","affiliation":[{"name":"VA HSR&amp;D Center for the Study of Healthcare Innovation, Implementation &amp; Policy (CSHIIP) VA Greater Los Angeles Healthcare System Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. 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