Social gradient in quality of life according to microscale neighbourhood features, Limassol, Cyprus

BACKGROUND: Beyond indices of socio-economic disadvantage (SED), not standard practice in Cyprus, neighbourhood audits provide information about environmental inequity not captured by other methods. Lack of spatial thinking often leads to attributing geographical differences to socio-demographic composition. METHODS: A random sample of 45 neighbourhoods along the SED continuum were audited using the Cyprus Neighborhood Observational Tool (CyNOTes). SED was defined according to a purposefully developed postcode level index (N = 124), by factor analyzing a set of census indicators. A sample of 10 residents aged 45-64 per neighborhood responded to a door-to-door SF-36 quality of life (QoL) survey (N = 450). Associations of QoL with SED and audit scores, organized in 9 domains, were explored in random-effect regression models adjusting for gender, age, education and income. RESULTS: The SED index captured a stepwise decrease across tertiles with increasing disadvantage in both Physical (-1.79 95% CI -2.84, -0.73; p < 0.001) and Mental (-1.42 95%CI -2.46, -0.59; p = 0.008) SF-36 Component Scores. Associations attenuated but remained statistically significant after adjusting for person-based social position. Re-classifying neighbourhoods according to audit ratings also revealed a social gradient for most CyNOTes domains. The domain with the strongest association with both Physical (-1.84 95%CI -2.88, -0.80; p < 0.001) and Mental SF-36 Scores (-1.88 95%CI -2.83, -0.93; p < 0.001) was “Pedestrian and Cycling Environment”. Associations persisted in adjusted models and appeared similar, if not stronger, to associations with the SED index. CONCLUSIONS: The study depicted the social gradient in quality of life among late working-life residents across Limassol neighbourhoods. Other than the expected patterning according to SED, audit indicators of environmental inequity also captured a social gradient, linking micro-scale neighborhood features to the residents’ quality of life. KEY MESSAGES: • A social gradient in quality of life was demonstrated along the socio-economic and environmental disadvantage in Limassol. • Depicting neighborhood microenvironment inequity can trigger and contextualize conversations about health and place among the local Public Health research and policy community.