Research on neighborhood effects on health in the United States: A systematic review of study characteristics

Socioeconomic Disparities in Prostate Cancer Treatment: The Impact of Area Deprivation Index on Initial Treatment Type for Localized PCa in a North-American Cohort

BACKGROUND

Socioeconomic status and geographical location contribute to disparities in localized prostate cancer (PCa) treatment. We examined the impact of area of deprivation index (ADI) on initial treatment type for localized PCa in a North-American cohort.

METHODS

We performed a retrospective analysis of patients diagnosed with localized PCa, treated within Henry Ford Health (HFH), between 1995 and 2022, with available ADI-data. ADI was assigned based on residential census block group, ranked as a national deprivation percentile. Patients were categorized into three treatment-groups: radical prostatectomy (RP), radiation therapy (RT) and "other" treatment. Using multinomial logistic regression, we assessed ADI impact on treatment choice. After excluding patients without cT, ISUP-grade and/or PSA, we stratified by D'Amico risk-classification and repeated the regression analysis in each subgroup.

RESULTS

Among 14,204 patients, 28.4% were NHB. Median (IQR) age at diagnosis was 65 (59-71) years. Median (IQR) ADI was 58 (36-83) for overall cohort and 51 (30-74), 66 (45-91), and 62 (39-88) for RP, RT, and "other" groups, respectively (p < 0.0001). Multivariable analysis showed ADI as an independent predictor of treatment choice (p = 0.01): for each 10-unit increase in ADI, patients were 3% more likely to receive RT and 10% less likely to receive RP. High ADI predicted a lower likelihood of receiving initial surgery across all risk-groups (p < 0.001).

CONCLUSIONS

Patients in more advantaged areas were more likely to receive RP, while those in disadvantaged areas received more RT. Recognizing how neighborhood factors affect treatment choices is crucial for improving health equity and reducing disparities in PCa outcomes.

Area-related sociodemographic factors and the risk of severe COVID-19: a longitudinal study of the total adult population in Sweden

INTRODUCTION

For public health purposes, it is essential to understand which population groups and their areas of residence are affected by a disease as COVID-19 and to what extent these groups are reached by preventive measures.

AIM

We investigated how individual-level and area-level characteristics are associated with COVID-19 morbidity and vaccine uptake.

METHODS

A population-based observational study including the total adult population age 18 and older in Sweden from 1 January 2020 to 1 April 2022, except individuals living in nursing homes. Associations between both individual and area-level characteristics and COVID-19 morbidity (hospitalisation, admission to intensive care unit and death) and vaccine uptake were analysed using Cox proportional hazards regression and adjusted for age, sex, comorbidity and socioeconomic and demographic factors.

RESULTS

In the fully adjusted model, the hazard ratio (HR) for COVID-19 hospitalisation was 34% lower for individuals living in the most affluent neighbourhoods (HR 0.66, 95%CI 0.63-0.68) compared to individuals in the most deprived neighbourhoods. For intensive care unit (ICU)-admission and COVID-19 death, the risks were 53% (HR 0.47, 95%CI 0.42-0.53) and 47% (HR 0.53, 95%CI 0.48-0.59) lower, respectively. When stratified by cross-classified sociodemographics, this pattern was consistent within all strata. A composite area-level measurement had a better predictive value compared to single measures.

CONCLUSIONS

Living in deprived neighbourhoods is associated with substantially higher risk of COVID-19 hospitalisation, ICU-admission, mortality and lower vaccine uptake. This risk factor remained strong even when taking individual level characteristics into account and within strata of individual-level factors.

Prevalence, patterns, and determinants of multimorbidity in South Africa: Insights from a nationally representative survey

BACKGROUND

Multimorbidity in Sub-Saharan Africa is under researched and includes distinct disease combinations to those seen in high income countries. The aim of this study was to determine the prevalence and distribution of multimorbidity in South Africa, as well as the associated individual, area-level and contextual factors.

METHODOLOGY

Multilevel logistic regression analyses were conducted on nationally representative 2016 South Africa Demographic Health Survey Data. The sample included 5,592 individuals (level 1) living in 691 neighbourhoods (level 2).

PRINCIPAL FINDINGS

Multimorbidity was present in 45.3% of the study population, ranging from 35.6% in Limpopo to 52.1% in Eastern Cape. Hypertension was the most prevalent condition (46.4%) followed by diabetes (22.6%). Individuals aged 65-95 had 11.57 times higher odds (95% CI 8.50-15.74) of multimorbidity compared to those aged 15-24. Women had nearly twice the odds of men (OR 1.95, 95% CI 1.68-1.27). Formerly married individuals had 1.63 times higher odds (95% CI 1.32-2.02) than never married. Compared to Black Africans, White individuals had 44% lower odds (OR 0.56, 95% CI 0.39-0.82) and those of mixed ethnicity had 31% lower odds (OR 0.69, 95% CI 0.51-0.92). Obesity increased the odds by 38% (OR 1.38, 95% CI 1.17-1.64) and occupational smoke exposure by 26% (OR 1.26, 95% CI 1.07-1.49). There was variation in multimorbidity at the neighbourhood level, with 2.9% of the variation attributable to contextual factors in the empty model. The median odds ratio was 1.35, indicating substantially higher odds of multimorbidity if an individual moved to a higher risk neighbourhood.

CONCLUSIONS

This study found a high burden of multimorbidity in South Africa patterned by demographic, socioeconomic, lifestyle and contextual factors. The results highlight the need for multilevel strategies to reduce multimorbidity and its inequities by addressing individual risk factors as well as neighbourhood-level determinants of health.

Considerations for the epidemiological evaluation of hyperlocal interventions: A case study of the New York City overdose prevention centers

To meet the needs of diverse communities, public health authorities are increasingly reliant on hyperlocal interventions targeting specific health issues and distinct populations. To facilitate epidemiological evaluation of hyperlocal interventions on community-level outcomes, we developed a framework of six practice-based considerations for researchers: spatial zone of impact, temporal resolution of impact, outcome of interest, definition of a plausible comparison group, micro vs. macro impacts, and practitioner engagement. We applied this framework to a case study of an impact evaluation of the New York City (NYC) overdose prevention centers (OPCs) on neighborhood-level drug-related arrests. We used drug arrest data from NYC from January 1, 2014, to September 30, 2023 and US Census data to conduct synthetic control modeling, comparing pre- and post-OPC arrests in the neighborhoods surrounding the two NYC OPCs (East Harlem and Washington Heights). We conducted sensitivity analyses to validate our results and compare our findings with those from a prior published study. Our findings indicate no significant change in drug-related arrests following the OPC openings. The mean absolute differences in daily drug-related arrests between the OPCs and their synthetic controls were 0.63 (p = 0.19) in East Harlem and 0.14 (p = 0.22) in Washington Heights. Sensitivity analyses corroborated our main results. Overall, findings demonstrate how our framework can be used to guide future epidemiological evaluations of diverse, hyperlocal public health interventions.

A Scoping Review of Neighborhood Effects and Health Among Children and Adolescents: Measurement and Design Characteristics

Decades of research have explored how neighborhood conditions relate to child and adolescent health, spawning numerous reviews focused on specific predictors, outcomes, or populations. Less is known about the design and characteristics underpinning this work. We conducted a scoping review of 754 studies examining neighborhood conditions and health-related factors among children and adolescents (aged 0-18) published between 2015 and 2024. This growing area of literature is largely based on observational, cross-sectional evidence of associations between objective socioeconomic status (SES) conditions and health, with over 100 studies focusing on associations between neighborhood SES and physical health, specifically. The findings of this review suggest that the current "state of the science" on neighborhoods and health among children and adolescents often does not lend itself to strong developmental conclusions, due to a reliance on observational, cross-sectional designs. Moreover, extant literature provides limited insight into whether neighborhood conditions beyond SES are associated with health. Longitudinal studies of multidomain neighborhood conditions and health represent important directions for future research.

Beyond the residential neighborhood: A scoping review of research on urban neighborhood networks

An emerging framework has expanded the neighborhood effects perspective by recognizing that exposure to, and the impact of, neighborhood conditions extend beyond the residential environment. This framework conceptualizes neighborhoods as embedded within a citywide network, with ties based on the durable, aggregated, and socially meaningful connections linking residents across a city. Measuring neighborhood conditions solely within residential areas may underestimate exposure to neighborhood conditions that are consequential for health. This paper presents results from a scoping review of the emerging neighborhood networks literature. We identified 32 U.S.-based studies published between 2014 and 2023. The overwhelming majority of these studies conceptualized neighborhood networks based on the aggregated daily mobility of residents, with 72 percent using either cell phone or social media data to construct neighborhood networks. Key empirical findings include evidence that durable patterns of racial/ethnic and income segregation generally extend into neighborhood networks and that network exposure to socioeconomic disadvantage is correlated with crime and poor health outcomes. Future research should examine other types of ties beyond those created via daily mobility, explore a wider range of exposures and outcomes, and investigate the implications of neighborhood networks on individual-level health.

Geospatial analysis of community-level social and environmental barriers for adult burn injury survivors in North Texas

PURPOSE

This study investigates geographic variations in community integration among burn injury survivors in North Texas and identifies community-level social and environmental factors that influence their post-injury community reintegration.

METHODS

We utilized data from the Burn Model System (BMS) National Database, focusing on 153 adult burn injury survivors in North Texas who sustained injuries between 2015 and 2022. We conducted county-level mapping to visualize temporal changes in Community Integration Questionnaire (CIQ) scores by comparing pre-injury scores to post-injury scores at 6 and 12 months. Next, we categorized counties into two groups: (1) counties with consistent declines in CIQ scores over the 12-month post-injury period, and (2) all other counties with burn injury survivors. We then compared county-level community characteristics between these two groups, focusing on four factors: socioeconomic conditions, access to healthcare, public safety, and the built environment.

RESULTS

There were geographic disparities in CIQ score changes among counties after burn injury. Counties with consistent decreases in CIQ scores had significantly higher levels of poverty, higher unemployment rates, increased crime rates, and lower access to healthy food options compared to other counties.

CONCLUSIONS

The findings suggest that rural counties may lack a supportive environment for burn injury survivors, highlighting the need for targeted interventions to promote community integration. Implementing strategies to reduce socioeconomic disparities, enhance public safety, and improve access to nutritious food could help facilitate better community reintegration outcomes for burn injury survivors. Furthermore, clinicians can leverage these insights by offering patient-level supports-such as localized telehealth services, peer support group referrals at discharge, and guidance on local resources-to help individuals navigate environmental barriers and maintain community engagement after returning home.

Neighborhood material versus social deprivation in Canada: different patterns of associations with child and adolescent mental health problems

PURPOSE

In a nationwide study, we aimed to study the association of neighborhood deprivation with child and adolescent mental health problems.

METHODS

We used data from the Canadian Health Survey on Children and Youth (N = 47,871; age range: 1-17 years) and linked these to Neighborhood Material and Social Deprivation data calculated using Canada's Census of Population. Using a series of logistic regressions, we studied the association between living in deprived areas and mental health problems among children and youth. We used bootstrap replicate weights for all analyses and adjusted them for individual sociodemographic characteristics.

RESULTS

In the adjusted model, the parent-reported developmental disorder was associated with more socially deprived neighborhoods (OR 1.29; 95% CI 1.07, 1.57 for most vs. least deprived quintiles). However, mental health service need or use was associated with living in less materially deprived areas (OR 0.78; 95% CI 0.63, 0.96 for most vs. least deprived quintiles). Among mental health problems reported by the youth (12-17 years old), poor/fair general mental health, alcohol drinking, and cannabis use were associated with neighborhood social deprivation in the adjusted models. In contrast, poor/fair general mental health, suicide ideas, alcohol drinking, and cannabis use were all negatively associated with higher materially deprived quintiles.

CONCLUSION

Our study provides further support for the existing evidence on the association between neighborhood deprivation, particularly social deprivation, and the mental health of children and adolescents. The findings can help public health policymakers and service providers better understand and address children's mental health needs in their neighborhoods.

Social Vulnerability and Biological Aging in New York City: An Electronic Health Records-Based Study

Chronological age is not an accurate predictor of morbidity and mortality risk, as individuals' aging processes are diverse. Phenotypic age acceleration (PhenoAgeAccel) is a validated biological age measure incorporating chronological age and biomarkers from blood samples commonly used in clinical practice that can better reflect aging-related morbidity and mortality risk. The heterogeneity of age-related decline is not random, as environmental exposures can promote or impede healthy aging. Social Vulnerability Index (SVI) is a composite index accounting for different facets of the social, economic, and demographic environment grouped into four themes: socioeconomic status, household composition and disability, minority status and language, and housing and transportation. We aim to assess the concurrent and combined associations of the four SVI themes on PhenoAgeAccel and the differential effects on disadvantaged groups. We use electronic health records data from 31,913 patients from the Mount Sinai Health System (116,952 person-years) and calculate PhenoAge for years with available laboratory results (2011-2022). PhenoAge is calculated as a weighted linear combination of lab results, and PhenoAgeAccel is the differential between PhenoAge and chronological age. A decile increase in the mixture of SVI dimensions was associated with an increase of 0.23 years (95% CI 0.21, 0.25) in PhenoAgeAccel. The socioeconomic status dimension was the main driver of the association, accounting for 61% of the weight. Interaction models revealed a more substantial detrimental association for women and racial and ethnic minorities with differences in leading SVI themes. These findings suggest that neighborhood-level social vulnerability increases the biological age of its residents, increasing morbidity and mortality risks. Socioeconomic status has the larger detrimental role among the different facets of social environment.

Reconceptualizing rurality: Exploring community capital to identify distinct rural classes in the United States

Background

In population health research, rurality is often defined using broad population density measures, which fail to capture the diverse and complex characteristics of rural areas. While researchers have developed more nuanced approaches to study neighborhood and area effects on health in urban settings, similar methods are rarely applied to rural environments. To address this gap, we aimed to explore dimensions of contextual heterogeneity across rural settings in the US.

Methods

We conducted an exploratory latent class analysis (LCA) to identify distinct classes of rurality. Using the Community Capitals Framework, we collated and analyzed nationally representative data for each domain of rural community capital across all rural census tracts in the US (n = 15,643). Data for this study were sourced from ten publicly available datasets spanning the years 2018-2021. To provide preliminary validation of our findings, we examined the Social Vulnerability Index (SVI) percentile rankings across the identified rural classes.

Results

A four-class model solution provided the best fit for our data. Our LCA results identified four distinct classes of rurality that vary in terms of capital types: Outlying (n = 3,566, 22.7%), Developed (n = 3,210, 20.5%), Well-Resourced (n = 4,896, 31.3%), and Adaptable (n = 3,981, 25.4%). The mean SVI percentile rankings differed significantly across these classes, with Well-Resourced having the lowest and Adaptable the highest mean percentile rankings.

Conclusions

We identified different types of rurality at the census tract level that fall along a social gradient as indicated by variation in SVI percentile rankings. These findings highlight that each rural class has a unique combination of community capitals. This nuanced approach to conceptualizing rurality provides the opportunity to identify interventions that meet specific rural communities' unique strengths and needs.

Area Poverty and Adverse Birth Outcomes: An Opportunity for Quality Improvement

OBJECTIVE

To evaluate the association between area poverty and adverse birth outcomes in the diverse birthing population of a large health system.

METHODS

This was a retrospective cohort study using electronic health record and hospital administrative data for pregnant people at nine hospitals within a large health system in the Chicago metropolitan area from 2018 to 2023. Patient addresses were geocoded and categorized by Census tract area percent poor households. Unadjusted and adjusted Poisson regression models, controlling for individual-level risk factors, evaluated the independent association between area poverty and birth outcomes to determine the degree to which this association is attenuated by the inclusion of individual-level factors in the model.

RESULTS

The study included 85,025 pregnant people. Area poverty was associated with sociodemographic factors, including young age, non-Hispanic Black race, Hispanic ethnicity, Medicaid insurance coverage, higher parity, and several comorbid conditions. Area poverty was associated with adverse birth outcomes and demonstrated a gradient effect with increasing area poverty in bivariable analyses. In unadjusted regression analyses, residence in areas with 5.0% or more poverty was associated with severe maternal morbidity, preterm birth, and low birth weight, and residence in areas with 8.0% or higher poverty was associated with neonatal intensive care unit admission. Although these associations persisted in multivariable analysis for severe maternal morbidity and neonatal intensive care unit admission, the associations with preterm birth and low birth weight persisted only for individuals residing in areas of 12.0% or higher poverty when controlling for individual-level risk factors.

CONCLUSION

Area poverty was associated with adverse birth outcomes in this birthing population even when controlling for individual-level risk factors, highlighting the need for system- and community-level quality-improvement interventions.

A paradox of white privilege: race, psychological resilience, and mental well-being during a public health crisis

OBJECTIVES

The present study sheds novel light on the so-called 'racial paradox in mental health,' i.e., the phenomenon that Blacks, despite their relative socioeconomic disadvantages are mentally healthier than their more privileged White counterparts in the US. Evidence from prior research has been largely based on non-probability or regional surveys fielded during 'ordinary' times. In contrast, we analyze probability data on American adults collected during the extraordinary period of the COVID-19 pandemic across the country.

DESIGN

Data came from the Census Household Pulse Survey (CHPS). The CHPS sampled community-dwelling U.S. adults across 50 States and the District of Columbia using the Master Address File (MAF). Data collection began on April 23 2020 and was carried out on a biweekly basis. We used three phases of data covering 21 weeks in total (with the week ending on February 1, 2021). Mixed-effects (multilevel) modeling was employed to analyze the data.

RESULTS

Statistical results show that compared to their Black counterparts Whites fared worse mentally during the pandemic. We also found that the magnitude of the focal association is stronger with greater vulnerability operationalized at the individual level, i.e., in the context of lower income, job insecurity, and food shortage. Additionally, significant cross-level interactions emerged: the effect of race was more pronounced in geographic regions with higher coronavirus infection, greater ethnic heterogeneity, and higher structural disadvantage.

CONCLUSION

Our research supports existing studies that Blacks vis-à-vis Whites are psychologically more resilient. We add to the literature by shedding novel light on the mental health paradox during the extraordinary times brought about by the COVID-19-induced public health crisis. Ironically, there is a mental cost involved with the 'White privilege' in the US.

Neighborhood socioeconomic disadvantage and child health: The role of neighborhood mobility networks

Despite a large body of work on neighborhood effects on health, past studies are limited in their treatment of neighborhoods as largely static spaces with (dis)advantages based primarily on the average characteristics of their residents. In this study, we draw on the triple neighborhood disadvantage perspective to explore how socioeconomic disadvantage in a neighborhood's mobility network uniquely relates to children's overall health levels, independent of residential disadvantage. We investigate this by combining 2019 SafeGraph data on mobility patterns from roughly 40 million U.S. mobile devices with information on children, families, and neighborhoods from the 2015-19 American Community Survey and 2019 Panel Study of Income Dynamics Child Development supplement. We find that mobility-based neighborhood disadvantage (MND) generally predicts child health better than residential neighborhood disadvantage (RND), but associations vary by race and by family income and are contingent on the broader metropolitan context. Our study advances existing research on the effects of mobility networks by shifting from analyzing aggregate-level outcomes to exploring how mobility-based disadvantage affects individual outcomes. Overall, our results indicate that the relationship between neighborhood disadvantage and child health is nuanced and complex. Findings from our study suggest that researchers aiming to understand the influence of neighborhood contexts should examine individuals' residential environments as well as the environments of neighborhoods connected through individuals' everyday mobility.

Differential associations of neighborhood disadvantage, race/ethnicity, and cognitive status with experiences of psychosocial distress in the HABS-HD cohort

INTRODUCTION

Understanding how contextual socioeconomic factors are associated with psychosocial distress among different ethnoracial groups is important for addressing health disparities in individuals at risk for Alzheimer's disease.

METHODS

Using Health and Aging Brain Study-Health Disparities (HABS-HD) data collected between 2017 and 2023, we examined the association of neighborhood disadvantage with psychosocial distress using demographically adjusted linear regression models, stratified by ethnoracial group and cognitive status.

RESULTS

We included 630 non-Hispanic Black, 1109 Hispanic, and 1068 non-Hispanic White older adults deemed cognitively normal (CN) or diagnosed with mild cognitive impairment (MCI). Residing in areas of greater neighborhood disadvantage was associated with increased chronic stress (CS) among CN White participants, but this relationship was attenuated among White participants with MCI. Regardless of cognitive status, severe levels of disadvantage were associated with increased CS and depression among Black participants.

DISCUSSION

Aging in more disadvantaged neighborhoods was associated with greater CS and depression for Black and White participants.

HIGHLIGHTS

Greater neighborhood disadvantage was associated with increased depression and chronic stress for White and Black individuals. Individuals with mild cognitive impairment reported greater levels of psychosocial distress. These findings are relevant for addressing mental health inequity in aging populations.

Individual and community socioeconomic status and receipt of influenza vaccines among adult primary care patients in a large academic health system: 2017-2019

Introduction

Influenza causes significant mortality and morbidity in the U.S., yet less than half of adults receive influenza vaccination. We use census-tract level social vulnerability index (SVI) to examine community- and individual-level characteristics of influenza vaccine coverage among primary care patients at an academic health system in Los Angeles, CA.

Methods

We used electronic medical records (EMR) data of 247,773 primary care patients for 2017-18 and 2018-19 influenza seasons. We geocoded patients' addresses to identify their SVI and merged them with EMR data. We specified mixed-effects logistic regression models estimating the association between patient's vaccine receipt and SVI, adjusting for sociodemographics, Charlson Comorbidity Index, and health insurance.

Results

Vaccination coverage was higher during the 2018-19 influenza season (34%) compared to the 2017-18 season (23%). In adjusted analyses, higher SVI, lower individual socioeconomic status and racial and ethnic minority status were independently associated with lower odds of vaccination. Patients on Medicaid had lower odds of vaccine receipt (adjusted Odds Ratio [aOR] = 0.77 for <65, aOR = 0.30 for 65+) than patients on commercial health insurance. Asian Non-Hispanic patients had higher odds than White Non-Hispanic patients (aOR = 2.39 for <65, aOR = 1.91 for 65+), while Black Non-Hispanic patients had lower odds (aOR = 0.49 for <65, aOR = 0.59 for 65+).

Conclusions

Community and individual socioeconomic status and race and ethnicity were associated with influenza vaccination. Health systems can use SVI to identify communities at increased risk of influenza mortality and morbidity, and engage with community partners to develop communication strategies and invest in interventions to increase vaccine accessibility in under-resourced neighborhoods.

Energy burden and mental health: A national study in the United States

The prevalence of mental health issues in the US has significantly risen over the past decade, and it is presumably linked to an energy burden issue that has recently gained attention as a critical social determinant of mental health. Utilizing extensive nationwide datasets at the census tract, we found that the census tract level energy burden is positively associated with two key mental health indicators even after accounting for living, housing, and sociodemographic characteristics: the prevalence of frequent mental distress and physician-diagnosed depression, across all US urban areas. We also observe that these associations are consistent across various climate regions. The findings highlight that energy burden has a detrimental impact on mental health, and that it should be e considered a significant social determinant of health in future studies. Lastly, our study advocates for national policies to achieve energy justice and address disparities in mental health.

Neighborhood Stressors and Epigenetic Age Acceleration Among Older Americans

OBJECTIVES

Exposure to stressful neighborhood environments is a well-established risk factor for health deterioration and premature death. However, the biological underpinnings are not fully understood. Epigenetic aging may function as a key molecular pathway to adverse health outcomes among residents of high-stress neighborhoods. This study examines the associations between neighborhood social stressors (socioeconomic deprivation, observed and perceived disorder, and low social cohesion) and epigenetic age (DunedinPACE and Principal component adjusted [PC] PCHorvath, PCHannum, PCPhenoAge, PCGrimAge). Further, we identify subpopulations most vulnerable to neighborhood stressors.

METHODS

Respondent data are from the 2016 Health and Retirement Study (HRS) DNA methylation subsample. Neighborhood data come from respondent reports (2014/2016) and the census (2012-2016 ACS). The analytic sample included 3,146 adults ages 56 and older (mean age = 68.8), of whom 54.9% were women and 19.3% were non-White.

RESULTS

In multilevel regression models adjusting for sociodemographic covariates, all neighborhood stressors were associated with faster DunedinPACE (B = 0.008 to 0.017). Neighborhood deprivation, perceived disorder, and low cohesion were associated with PCPhenoAge (B = 0.27 to 0.40) or PCGrimAge acceleration (B = 0.23). Health behaviors explained these associations to some degree. However, no significant associations were found with PCHorvath and PCHannum. In interaction analyses, adverse associations with deprivation, observed disorder, and low cohesion were more pronounced for women. No consistent interactions were found for race/ethnic and education groups.

DISCUSSION

Our findings indicate that neighborhood stressors can accelerate epigenetic aging, with older women particularly vulnerable to their effects. These findings provide insights into the biological foundations of health disparities rooted in neighborhood environments.

Association between snack intake behaviors of children and neighboring women: A population-based cross-sectional analysis with spatial regionalization

Background

Accumulated evidence indicates that neighborhood environments affect children's health behaviors. However, measuring neighborhood environments remains challenging because there exist strengths and weaknesses both in objective and perceived environment measures. Drawing on a recent conceptual model of how environment, perception, and behavior interact, we hypothesized that neighbors' behavioral similarities indicate the combined influence of physical and social environmental opportunities on specific behaviors. We then examined how these similarities (i.e. the behavioral tendencies of children's adult neighbors) relate to children's obesogenic dietary behaviors.

Methods

We used data for 2275 women and 821 elementary schoolchildren from a 2012-2013 population-based survey in greater Tokyo, Japan. Snack intake was defined as the total consumption of various types of snacks, estimated using a validated self-administered diet history questionnaire. Spatial regionalization, a type of spatial clustering, was used to empirically identify segments that could effectively differentiate regional variation in women's snack intake behaviors. We conducted multiple regression analysis to assess the cross-sectional association between children's snack intake and the mean snack intake of neighborhood women, adjusting for mother's intake.

Results

A 1-g increase in the mean snack intake of neighborhood women was associated with a 0.23-g (95% confidence interval: 0.00-0.45) increase in children's intake, while a 1-g increase in mother's intake was associated with a 0.34-g (95% confidence interval: 0.26-0.41) increase in children's intake.

Discussion

The results suggest that the out-of-home physical and social neighborhood environments may have non-ignorable associations with children's dietary behaviors by offering behavioral opportunities in addition to maternal influence.

Local crime and substance use disorders: A comparison of midlife adults in the 1990s and 2000s

This study investigated how sociopolitical changes in the United States between the 1990s and 2000s may explain the increase in substance use disorders and reduced longevity in more recent cohorts of US midlife adults. The 2008 recession which drastically increased unemployment rates across the country may have had negative implications for downstream contextual and individual processes, including both local crime rates and substance use disorders. The Midlife in the United States Survey cohort (1995; n = 6148; 20-75 years) and the MIDUS Refresher cohort (2011; n = 3543; 23-76 years) reported on substance use disorders. These data were linked to Uniform Crime Reporting violent crime rates to determine whether associations between local crime and substance use disorders changed among two separate cohorts of US midlife adults assessed before or after the 2008 recession. In 1995, despite higher local crime rates, substance use disorders were not associated with local crime. The comparatively lower crime rates of 2011, however, associated with greater prevalence of substance use disorders. Considering unemployment rates from the Decennial Census and American Community Survey, which were substantially higher in 2011 relative to 1995, completely diminished the local crime rate-substance use disorder association. The increased prevalence of substance use disorders observed in the more recent cohort of midlife adults assessed in the current study may represent maladaptive coping to local crime after the 2008 recession.

Association of race and area of deprivation index with prostate cancer incidence and lethality: results from a contemporary North American cohort

BACKGROUND

Socioeconomic and demographic factors contribute to disparity in prostate cancer (PCa) outcomes. We examined the impact of Area of Deprivation Index (ADI) and race on PCa incidence and lethality in a North American cohort.

METHODS

Our cohort included men who received at least 1 prostate-Specifig Antigen (pSA) test within our Health System (1995-2022). An ADI score was assigned to each patient based on their residential census block, ranked as a percentile of deprivation relative to the national level. Individuals were further categorized into quartiles, where the fourth one (ADI 75-100) represented those living in the most deprived areas. We investigated PCa incidence and lethality, using cumulative incidence estimates and competing-risk regression. An ADI × Race interaction term examined whether the relationship between ADI and outcomes varied based on race.

RESULTS

We included 134 366 patients, 25% of whom were non-Hispanic Black (NHB). Median (IQR) follow-up was 8.8 (5-17) years. At multivariate analysis, individuals from the third quartile (ADI 50-74, 95% CI = 0.83 to 0.95) and the fourth quartile (ADI ≥75, 95% CI = 0.75 to 0.86) showed significant reduced hazard ratios for PCa incidence, when compared with the first quartile (ADI <25, all P < .001). In contrast to the overall cohort, PCa incidence increased with ADI in NHB men, who were persistently at higher hazard for both PCa incidence and lethality than non-Hispanic White (NHW), across all ADI strata (all P < .001).

CONCLUSIONS

Living in more deprived areas was associated with lower PCa incidence and higher lethal disease rate. Conversely, PCa incidence increased with ADI for NHB, who consistently showed worse outcomes than NHW individuals, regardless of ADI.

Development of Composite Measures of Neighborhood Economic Factors for Use in Spinal Cord Injury Outcomes Studies: A Spinal Cord Injury Model Systems Database Study

OBJECTIVE

To develop composite measures of neighborhood economic factors for use with the national Spinal Cord Injury Model Systems (SCIMSs) database in cross-sectional and longitudinal investigations of the social determinants of health.

DESIGN

Secondary data analysis of administrative data from the 2009, 2014, and 2019 American Community Survey (ACS) 5-year estimates and survey data collected for the SCIMS database.

SETTING

Community.

PARTICIPANTS

The validity of the neighborhood economic measures developed from the ACS data was tested with a sample of SCIMS participants who completed a follow-up interview between 2017 and 2021 (N=8,130). The predictive validity of the neighborhood measures was assessed with a subsample of cases with complete data on the outcome and covariate measures (N=6,457).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

A binary measure of self-rated health status (1=poor/fair health; 0=good/very good/excellent).

RESULTS

A combination of panel review and data reduction techniques yielded 2 distinct measuring neighborhood socioeconomic status (SES) and neighborhood socioeconomic disadvantage that were validated using 3 waves of ACS data and the SCIMS data. The odds of reporting poor health were lower among people living in moderate- and high-SES neighborhoods and highest among people living in moderately and highly disadvantaged neighborhoods. The negative association between neighborhood SES and poor health was fully attenuated by differences in participants' individual demographic and economic characteristics whereas the positive association between neighborhood disadvantage and poor health persisted after adjusting for individual differences.

CONCLUSIONS

The two composite measures of neighborhood economic factors developed by this study are robust in samples from different periods of time and valid for use with the SCIMS database. Future investigations conducting surveillance of the needs of the SCI population using this resource may consider using these measures to assess the effect of the social determinants of health in outcomes after SCI.

Neighborhood Deprivation is Associated With Increased Postoperative Complications After Implant-Based Breast Reconstruction

PURPOSE

The Area Deprivation Index (ADI) ranks neighborhoods by deprivation based on US Census data. This study utilizes ADI scores to investigate the impact of neighborhood deprivation on complication rates following breast reconstruction.

PATIENTS AND METHODS

Patients who received implant-based reconstruction from 2019 to 2023 were identified at a single institution in New York. Patients were linked to a state-specific ADI score and categorized into groups: "High ADI" (6-10) and "Low ADI" (1-5). Patient characteristics and complication rates were compared between the ADI groups with Chi-Square analysis and t-tests. The predictive value of ADI scores on complication rates was assessed using logistic regression models.

RESULTS

In total, 471 patients were included, of which 16% (n = 73) were in the High ADI group, and 84% (n = 398) were in the Low ADI group. There were no baseline differences between the 2 groups, except that there were more patients of Hispanic descent in the High ADI group (30% vs. 15%, P < .01). The High ADI group had a higher overall complication rate than the Low ADI group (34% vs. 21%, P < .01), as well as higher individual rates of hematoma (12% vs. 3%, P < .01) and unexpected reoperations (18% vs. 7%, P < .01). After adjusting for differences in race, High ADI scores predicted hematoma, reoperations, and any complication (P < .05).

CONCLUSION

Patients living in neighborhoods with high ADI had a higher incidence of postoperative complications, independent of comorbidities and race. This measure of disparity should be considered when counselling patients about their risk of complications following procedures like implant-based breast reconstruction.

Socio-spatial trajectories and health disparities among older adults in Chile

In this study, we examine residential trajectories since birth among older adults in the Santiago Metropolitan Area, Chile, and their association with health outcomes. We linked retrospective residential information for a sample of 802 individuals aged 65-75 in 2019 to context-based information from decennial censuses. Our analysis reveals substantive heterogeneity in individuals' residential trajectories, thus mirroring social and urban changes in Chile's largest city. We found significant associations between residential histories and health outcomes at the time of the interview. Consistent residence in advantaged areas was linked to better health, whereas relocating to the metropolitan area from elsewhere was generally linked to poorer health, except for those moving to emerging middle-class areas. These findings underscore the importance of longitudinal and life course approaches in understanding the complex relationship between place and health.

Novel Characterization of Socioecological Determinants of Health in Rural Alabama

INTRODUCTION

Socioecological determinants of health (SEDOHs) influence disparities in surgical outcomes. However, SEDOHs are challenging to measure, limiting our ability to address disparities. Using a validated survey (SEDOH-88), we assessed SEDOHs in three rural communities in Alabama. We hypothesized that SEDOHs would vary significantly across sites but measuring them would be acceptable and feasible.

MATERIALS AND METHODS

This was a retrospective review of a prospectively maintained database involving surgical patients who completed the SEDOH-88 and a secondary survey assessing it's acceptability or feasibility from August 2021 to July 2023. Included patients underwent endoscopic, minimally invasive, or open surgery at three rural hospitals: Demopolis (DM), Alexander City (AC), and Greenville (GV).

RESULTS

The 107 participants comprised 48 (44.9%) from DM, 27 (25.2%) from AC, and 32 (29.9%) from GV, respectively. The median age was 64 y, and 65.6% were female. When comparing DM to AC and GV by individual factors, DM had the largest Black population (78.7 versus 22.2 versus 48.3%, P < 0.001) and more often required help reading hospital materials (20.5 versus 3.7 versus 10.3%, P = 0.007). When comparing DM to AC and GV by structural and environmental factors, DM had more Medicaid enrollees (27.3 versus 3.7 versus 6.9%, P = 0.033) and lacked fresh produce (18.2 versus 25.9 versus 39.3%, P = 0.033) and internet access (63.6 versus 100.0 versus 86.2%, P < 0.001). The SEDOH-88 had an overall 90.9% positive acceptability and feasibility score.

CONCLUSIONS

SEDOHs varied significantly across rural communities regarding individual (race or health literacy), structural (insurance), and environmental-level factors (nutritious food or internet access). The high acceptability and feasibility of the SEDOH-88 shows it's potential utility in identifying targets for future disparity-reducing interventions.

Individual-Level and Community-Level Predictors of Healthy Pregnancy Outcomes in Multigravid Black Women

OBJECTIVE

To identify individual- and community-level factors that predict the odds of multigravid Black women having consecutive pregnancies without adverse pregnancy outcomes.

METHODS

We conducted a secondary analysis of 515 multigravid Black women from a longitudinal observational study (2017-2019). We assessed the presence of adverse pregnancy outcomes (hypertensive disorders, gestational diabetes, preterm birth, fetal growth restriction, placental abruption, and pregnancy loss) for the index and prior pregnancies. We examined U.S. Census data, medical records, and surveys across multiple socioecologic domains: personal, behavioral, socioeconomic, and policy. We estimated adjusted odds ratios (aORs) and 95% CIs for the association between individual- and community-level factors and consecutive healthy pregnancies using hierarchical logistic regression models adjusted for maternal age, body mass index (BMI), gravidity, interpregnancy interval, and median household income.

RESULTS

Among 515 multigravid Black women (age 27±5 years, BMI 31.4±8.9, gravidity 4±2), 38.4% had consecutive healthy pregnancies without adverse pregnancy outcomes. Individual-level factors associated with consecutive healthy pregnancies included normal glucose tolerance (aOR 3.9, 95% CI, 1.2-12.1); employment (aOR 1.9, 95% CI, 1.2-2.9); living in communities with favorable health indicators for diabetes, hypertension, and physical activity; and household income of $50,000 per year or more (aOR 3.5, 95% CI, 1.4-8.7). When individual and community factors were modeled together, only income and employment at the individual and community levels remained significant.

CONCLUSION

Individual and community income and employment are associated with consecutive healthy pregnancies in a cohort of Black patients, emphasizing the need for comprehensive, multilevel systems interventions to reduce adverse pregnancy outcomes for Black women.

Neighborhood social composition and refugee mental health - quasi-experimental evidence of associations from a Danish population register study

BACKGROUND

Refugees are at an elevated risk of some mental disorders with studies highlighting the contributing role of post-migration factors. Studies of migrant groups show neighborhood social composition, such as ethnic density, to be important. This is the first longitudinal study to examine this question for refugees and uses a novel quasi-experimental design.

METHODS

We followed a cohort of 44 033 refugees from being first assigned housing under the Danish dispersal policy, operating from 1986 to 1998, until 2019. This comprised, in effect, a natural experiment whereby the influence of assigned neighborhood could be determined independently of endogenous factors. We examined three aspects of neighborhood social composition: proportion of co-nationals, refugees, and first-generation migrants; and subsequent incidence of different mental disorders.

RESULTS

Refugees assigned to neighborhoods with fewer co-nationals (lowest v. highest quartile) were more likely to receive a subsequent diagnosis of non-affective psychosis, incident rate ratio (IRR) 1.25 (95% confidence interval (CI) 1.06-1.48), and post-traumatic stress disorder (PTSD), IRR 1.21 (95% CI I.05-1.39). A comparable but smaller effect was observed for mood disorders but none observed for stress disorders overall. Neighborhood proportion of refugees was less clearly associated with subsequent mental disorders other than non-affective psychosis, IRR 1.24 (95% CI 1.03-1.50). We found no statistically significant associations with proportion of migrants.

CONCLUSIONS

For refugees, living in a neighborhood with a lower proportion of co-nationals is related to subsequent increased risk of diagnosed mental disorders particularly non-affective psychosis and PTSD.

Neighborhood selection by parent personality, depression, and coparent support: A two-study replication

This study addresses the degree to which three selection factors (parent personality, depression, and coparent support) drive movement into neighborhoods and predict changes in youth externalizing behavior. Two studies followed children from birth to age 15 (N = 1,364 for Study 1; N = 4,898 for Study 2). Neighborhood socioeconomic disadvantage, family income, and youth externalizing behavior were consistently and significantly correlated cross sectionally and longitudinally. Selection factors predicted changes in youth externalizing behavior. Higher family income, mother agreeableness, and perceived support from a coparent predicted movement over time into less disadvantaged neighborhoods. Lower levels of mother impulsivity, neuroticism, and depression also predicted movement over time into less disadvantaged neighborhoods. Neighborhood disadvantage did not predict change in youth externalizing behavior when any of the above selection factors were included in the model. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The health implications of neighborhood networks based on daily mobility in US cities

A large body of research has been dedicated to understanding the neighborhood conditions that impact health, which outcomes are affected, and how these associations vary by demographic and socioeconomic neighborhood and individual characteristics. This literature has focused mostly on the neighborhoods in which individuals reside, thus failing to recognize that residents across race/ethnicity and class spend a non-trivial amount of their time in neighborhoods far from their residential settings. To address this gap, we use mobile phone data from the company SafeGraph to compare racial inequality in neighborhood socioeconomic advantage exposure across three scales: the neighborhoods that residents live in, their adjacent neighborhoods, and the neighborhoods that they regularly visit. We found that the socioeconomic advantage levels in neighborhood networks differ from the levels at the residential and adjacent scales across all ethnoracial neighborhoods. Furthermore, socioeconomic advantage at the network level is associated with diabetes and hypertension prevalence above and beyond its impact at the residential and adjacent levels. We also find ethnoracial differences in these associations, with greater beneficial consequences of network socioeconomic advantage exposure on hypertension and diabetes for white neighborhoods. Future social determinants of health research needs to reconceptualize exposure to include the larger neighborhood network that a community is embedded in based on where their residents travel to and from.

Comparing two measures of neighborhood quality and internalizing and externalizing behaviors in the adolescent brain cognitive development study

PURPOSE

There is widespread recognition of the importance and complexity of measuring neighborhood contexts within research on child psychopathology. In this study, we assessed the cross-sectional associations between two measures of neighborhood quality and internalizing and externalizing behaviors in preadolescence.

METHODS

Drawing on baseline data from the Adolescent Brain Cognitive Development Study (n = 10,577 preadolescents), we examined two multi-component assessments of neighborhood quality in relation to children's internalizing and externalizing symptoms: the Area Deprivation Index (ADI), which measures socioeconomic adversity, and the Child Opportunity Index 2.0 (COI), which measures economic, educational, and environmental opportunity. Both measures were categorized into quintiles. We then used mixed-effects linear regression models to examine bivariate and adjusted associations.

RESULTS

The bivariate associations displayed strong inverse associations between the COI and ADI and externalizing symptoms, with a graded pattern of fewer externalizing behaviors with increasing neighborhood quality. Only the ADI was associated with externalizing behaviors in models adjusted for child and family characteristics. We did not observe a clear association between either measure of neighborhood quality and internalizing behaviors in bivariate or adjusted models.

CONCLUSIONS

Neighborhood quality, as measured by the COI and ADI, was associated with externalizing behaviors in preadolescent children. The association using the ADI persisted after adjustment for family-level characteristics, including financial strain. Our results indicate that different assessments of neighborhood quality display distinct associations with preadolescent behavioral health. Future research is needed to assess the association between neighborhood quality and behavior trajectories and to identify place-based intervention strategies.

Assessing the Relationship Between Neighborhood Socioeconomic Disadvantage and Telemedicine Use Among Patients With Breast Cancer and Examining Differential Provisions of Oncology Services Between Telehealth and In-Person Visits: Quantitative Study

BACKGROUND

Since the COVID-19 pandemic began, we have seen rapid growth in telemedicine use. However, telehealth care and services are not equally distributed, and not all patients with breast cancer have equal access across US regions. There are notable gaps in existing literature regarding the influence of neighborhood-level socioeconomic status on telemedicine use in patients with breast cancer and oncology services offered through telehealth versus in-person visits.

OBJECTIVE

We assessed the relationship between neighborhood socioeconomic disadvantage and telemedicine use among patients with breast cancer and examined differential provisions of oncology services between telehealth and in-person visits.

METHODS

Neighborhood socioeconomic disadvantage was measured using the Area Deprivation Index (ADI), with higher scores indicating greater disadvantages. Telemedicine and in-person visits were defined as having had a telehealth and in-person visit with a provider, respectively, in the past 12 months. Multivariable logistic regression was performed to examine the association between ADI and telemedicine use. The McNemar test was used to assess match-paired data on types of oncology services comparing telehealth and in-person visits.

RESULTS

The mean age of the patients with breast cancer (n=1163) was 61.8 (SD 12.0) years; 4.58% (52/1161) identified as Asian, 19.72% (229/1161) as Black, 3.01% (35/1161) as Hispanic, and 72.78% (845/1161) as White. Overall, 35.96% (416/1157) had a telemedicine visit in the past 12 months. Of these patients, 65% (266/409) had a videoconference visit only, 22.7% (93/409) had a telephone visit only, and 12.2% (50/409) had visits by both videoconference and telephone. Higher ADI scores were associated with a lower likelihood of telemedicine use (adjusted odds ratio [AOR] 0.89, 95% CI 0.82-0.97). Black (AOR 2.38, 95% CI 1.41-4.00) and Hispanic (AOR 2.65, 95% CI 1.07-6.58) patients had greater odds of telemedicine use than White patients. Compared to patients with high school or less education, those with an associate's degree (AOR 2.67, 95% CI 1.33-5.35), a bachelor's degree (AOR 2.75, 95% CI 1.38-5.48), or a graduate or professional degree (AOR 2.57, 95% CI 1.31-5.04) had higher odds of telemedicine use in the past 12 months. There were no significant differences in providing treatment consultation (45/405, 11.1% vs 55/405, 13.6%; P=.32) or cancer genetic counseling (11/405, 2.7% vs 19/405, 4.7%; P=.14) between telehealth and in-person visits. Of the telemedicine users, 95.8% (390/407) reported being somewhat to extremely satisfied, and 61.8% (254/411) were likely or very likely to continue using telemedicine.

CONCLUSIONS

In this study of a multiethnic cohort of patients with breast cancer, our findings suggest that neighborhood-level socioeconomic disparities exist in telemedicine use and that telehealth visits could be used to provide treatment consultation and cancer genetic counseling. Oncology programs should address these disparities and needs to improve care delivery and achieve telehealth equity for their patient populations.

Measuring variation in infant mortality and deaths of despair by US congressional district in Pennsylvania: a methodological case study

Many ecological studies examine health outcomes and disparities using administrative boundaries such as census tracts, counties, or states. These boundaries help us to understand the patterning of health by place, along with impacts of policies implemented at these levels. However, additional geopolitical units (units with both geographic and political meaning), such as congressional districts (CDs), present further opportunities to connect research with public policy. Here we provide a step-by-step guide on how to conduct disparities-focused analysis at the CD level. As an applied case study, we use geocoded vital statistics data from 2010-2015 to examine levels of and disparities in infant mortality and deaths of despair in the 19 US CDs of Pennsylvania for the 111th-112th (2009-2012) Congresses and 18 CDs for the 113th-114th (2013-2016) Congresses. We also provide recommendations for extending CD-level analysis to other outcomes, states, and geopolitical boundaries, such as state legislative districts. Increased surveillance of health outcomes at the CD level can help prompt policy action and advocacy and, hopefully, reduce rates of and disparities in adverse health outcomes.

The embodiment of the neighborhood socioeconomic environment in the architecture of the immune system

There is growing recognition of the importance of immune health for understanding the origins of ageing-related disease and decline. Numerous studies have demonstrated consistent associations between the social determinants of health and immunosenescence (i.e. ageing of the immune system). Yet few studies have interrogated the relationship between neighborhood socioeconomic status (nSES) and biologically specific measures of immunosenescence. We used data from the US Health and Retirement Study to measure immunosenescence linked with neighborhood socioeconomic data from the National Neighborhood Data Archive to examine associations between indicators of nSES and immunosenescence. We found associations between both the ratio of terminally differentiated effector memory to naïve (EMRA:Naïve) CD4+ T cells and cytomegalovirus (CMV) immunoglobulin G (IgG) levels and nSES. For the CD4+ EMRA:Naïve ratio, each 1% increase in the neighborhood disadvantage index was associated with a 0.005 standard deviation higher value of the EMRA:Naïve ratio (95% CI: 0.0003, 0.01) indicating that living in a neighborhood that is 10% higher in disadvantage is associated with a 0.05 higher standardized value of the CD4+ EMRA:Naïve ratio. The results were fully attenuated when adjusting for both individual-level SES and race/ethnicity. For CMV IgG antibodies, a 1% increase in neighborhood disadvantage was associated a 0.03 standard deviation higher value of CMV IgG antibodies (β = 0.03; 95% CI: 0.002, 0.03) indicating that living in a neighborhood that is 10% higher in disadvantage is associated with a 0.3 higher standardized value of CMV. This association was attenuated though still statistically significant when controlling for individual-level SES and race/ethnicity. The findings from this study provide compelling initial evidence that large, nonspecific social exposures, such as neighborhood socioeconomic conditions, can become embodied in cellular processes of immune ageing.

Acculturation and Disparities in Telemedicine Readiness: A National Study

Telemedicine provided older adults the ability to safely seek care during the coronavirus disease (COVID-19) pandemic. This study aimed to evaluate the potential impact of acculturation factors in telemedicine uptake between ethnic groups. As part of the National Health and Aging Trends Study 2018 survey, 303 participants (≥65 years) were interviewed. We assessed the impact of acculturation on telemedicine readiness by race and ethnicity. Compared to the white non-Hispanic immigrant population, Hispanic and Asian/Pacific Islander (API) populations had significantly lower telemedicine readiness and uptake. Limited English proficiency or older age at the time of migration was associated with telemedicine unreadiness and uptake in the Hispanic and API populations. Our findings suggested that acculturation factors play a substantial role in telemedicine uptake among older adult immigrants in the United States. Therefore, acculturation factors should be considered when promoting and adopting telemedicine technologies in older adults.

Leveraging Electronic Health Records to Assess Residential Mobility Among Veterans in the Veterans Health Administration

BACKGROUND

Residential mobility, or a change in residence, can influence health care utilization and outcomes. Health systems can leverage their patients' residential addresses stored in their electronic health records (EHRs) to better understand the relationships among patients' residences, mobility, and health. The Veteran Health Administration (VHA), with a unique nationwide network of health care systems and integrated EHR, holds greater potential for examining these relationships.

METHODS

We conducted a cross-sectional analysis to examine the association of sociodemographics, clinical conditions, and residential mobility. We defined residential mobility by the number of VHA EHR residential addresses identified for each patient in a 1-year period (1/1-12/31/2018), with 2 different addresses indicating one move. We used generalized logistic regression to model the relationship between a priori selected correlates and residential mobility as a multinomial outcome (0, 1, ≥2 moves).

RESULTS

In our sample, 84.4% (n=3,803,475) veterans had no move, 13.0% (n=587,765) had 1 move, and 2.6% (n=117,680) had ≥2 moves. In the multivariable analyses, women had greater odds of moving [aOR=1.11 (95% CI: 1.10,1.12) 1 move; 1.27 (1.25,1.30) ≥2 moves] than men. Veterans with substance use disorders also had greater odds of moving [aOR=1.26 (1.24,1.28) 1 move; 1.77 (1.72,1.81) ≥2 moves].

DISCUSSION

Our study suggests about 16% of veterans seen at VHA had at least 1 residential move in 2018. VHA data can be a resource to examine relationships between place, residential mobility, and health.

Social Vulnerability and Biological Aging in New York City: An Electronic Health Records-Based Study

Chronological age is not an accurate predictor of morbidity and mortality risk, as individuals' aging processes are diverse. Phenotypic age acceleration (PhenoAgeAccel) is a validated biological age measure incorporating chronological age and biomarkers from blood samples commonly used in clinical practice that can better reflect aging-related morbidity and mortality risk. The heterogeneity of age-related decline is not random, as environmental exposures can promote or impede healthy aging. Social Vulnerability Index (SVI) is a composite index accounting for different facets of the social, economic, and demographic environment grouped into four themes: socioeconomic status, household composition and disability, minority status and language, and housing and transportation. We aim to assess the concurrent and combined associations of the four SVI themes on PhenoAgeAccel and the differential effects on disadvantaged groups. We use electronic health records data from 31,913 patients from the Mount Sinai Health System (116,952 person-years) and calculate PhenoAge for years with available laboratory results (2011-2022). PhenoAge is calculated as a weighted linear combination of lab results and PhenoAgeAccel is the differential between PhenoAge and chronological age. A decile increase in the mixture of SVI dimensions was associated with an increase of 0.23 years (95% CI: 0.21, 0.25) in PhenoAgeAccel. The socioeconomic status dimension was the main driver of the association, accounting for 61% of the weight. Interaction models revealed a more substantial detrimental association for women and racial and ethnic minorities with differences in leading SVI themes. These findings suggest that neighborhood-level social vulnerability increases the biological age of its residents, increasing morbidity and mortality risks. Socioeconomic status has the larger detrimental role amongst the different facets of social environment.

The effects of two types of neighborhood factors on trajectory of internalizing and externalizing symptoms from early childhood to adolescence

Although a robust body of previous empirical studies investigated the long-term trend of child behavior problems, limited research discussed the influences of various types of neighborhood factors on such trajectory (e.g., neighborhood structural characteristics and collective efficacy). Using a nationally representative longitudinal dataset the Fragile Families and Child Wellbeing Study (FFCWS), with six waves from 1998 to 2017, this study captures the longitudinal effects of two types of early childhood neighborhood factors on the co-development of internalizing and externalizing symptoms. Data was collected at the focal child's age 3, age 5, age 9, age 15 (N = 2,385), and the parallel-process growth curve models were applied. Results suggest that the trajectories of both internalization and externalizing symptoms showed U-shape and bidirectional relationships among internalizing and externalizing problems. The long-term effects of neighborhood social cohesion and economic disadvantages were significantly associated with children's internalizing and externalizing symptoms. The implication of this study was further discussed.

This is the place: a multi-level analysis of neighbourhood correlates of adolescent wellbeing

OBJECTIVE

Adolescent wellbeing is a key research and policy priority, but little is known about neighbourhood-level influences. This study examined the extent to which adolescents' life satisfaction and internalising symptoms vary between neighbourhoods, and which neighbourhood characteristics are associated with individual outcomes.

METHOD

Baseline data from the #BeeWell cohort study in Greater Manchester (England) including 35,902 adolescents (aged 12-15) across 243 neighbourhoods were linked to neighbourhood characteristics (e.g. access to education and health services, leisure facilities) from the Co-op's Community Wellbeing Index and analysed using multi-level regression.

RESULTS

Neighbourhoods explained 0.61% and 1.17% of the variation in life satisfaction and internalising symptoms, respectively. Socio-demographic inequalities in these outcomes varied across neighbourhoods. Several neighbourhood characteristics were associated with wellbeing, but differences across model specifications were observed (e.g. adjusted vs unadjusted; unique associations vs grouped domains). However, higher levels of perceived wellbeing support from local people were associated with lower internalising symptoms in all models. Other characteristics associated with better wellbeing outcomes in various models included lower GP antidepressant prescription rates, and better access to health services, areas for leisure, and good places to spend free time.

CONCLUSION

Neighbourhoods account for a small but significant proportion of the variance in adolescent life satisfaction and internalising symptoms. Some neighbourhood characteristics (notably neighbourhood social capital) are associated with these outcomes at the individual level, and disparities in these outcomes for some groups vary across neighbourhoods. Our findings speak to the role of place as a determinant of adolescent wellbeing, with consequent implications for intervention.

Unpacking Neighborhood Socioeconomic Status in Children's Health Research from an Environmental Justice Perspective: A Scoping Review

PURPOSE OF REVIEW

Clearly defining and measuring neighborhood socioeconomic status (nSES) is a key first step in achieving environmental justice, as the disproportionate distribution of environmental hazards and access to resources is heavily influenced by socioeconomic factors. This scoping review explores the definition of neighborhoods, measurement of neighborhood socioeconomic status (nSES), and studies that evaluated the association between nSES and child health in accordance with PRISMA guidelines.

RECENT FINDINGS

We identified 4112 articles published on US pediatric populations between 2013 and 2022. We identified 170 distinct indicators across seven broad domains of nSES used to create 121 different measures of nSES across the 206 publications included in this review. While there is considerable interest in nSES and children's health, there is also substantial variation in the measurement of neighborhood as a geographic unit and nSES as a construct. We observed methodological challenges related to the identification of neighborhood boundaries, indicator selection, and nSES measure definition(s). We discuss common pitfalls in neighborhood research that can complicate identifying, targeting, and resolving environmental injustices. Lastly, we put forward a series of recommendations to reduce measurement error and improve inference, in addition to reporting recommendations for neighborhoods and health research that can aid in improving our understanding of pathways between neighborhood context and child health, inform policy development, and allocate resources to achieve environmental justice.

Neighborhood Archetypes and Cardiovascular Health in Black Breast Cancer Survivors

Background

Maintaining cardiovascular health (CVH) is critical for breast cancer (BC) survivors, particularly given the potential cardiotoxic effects of cancer treatments. Poor CVH among Black BC survivors may be influenced by various area-level social determinants of health, yet the impact of neighborhood archetypes in CVH among this population remains understudied.

Objectives

This study aimed to characterize the neighborhood archetypes where Black BC survivors resided at diagnosis and evaluate their associations with CVH.

Methods

We assessed CVH 24 months post-diagnosis in 713 participants diagnosed between 2012 and 2017 in the Women's Circle of Health Follow-Up Study, a population-based study of Black BC survivors in New Jersey. Neighborhood archetypes, identified via latent class analysis based on 16 social and built environment features, were categorized into tertiles. Associations between neighborhood archetypes and CVH scores were estimated using polytomous logistic regression.

Results

CVH scores were assessed categorically (low, moderate, and optimal) and as continuous variables. On average, Black BC survivors achieved only half of the recommended score for optimal CVH. Among the 4 identified archetypes, women in the Mostly Culturally Black and Hispanic/Mixed Land Use archetype showed the lowest CVH scores. Compared to this archetype, Black BC survivors in the Culturally Diverse/Mixed Land Use archetype were nearly 3 times as likely to have optimal CVH (relative risk ratio: 2.92; 95% CI: 1.58-5.40), with a stronger association observed in younger or premenopausal women. No significant CVH differences were noted for the other 2 archetypes with fewer built environment features.

Conclusions

Neighborhood archetypes, integrating social and built environment factors, may represent crucial targets for promoting CVH among BC survivors.

Climate change anxiety, hurricane exposure, and climate change actions and attitudes: results from a representative, probability-based survey of US Gulf Coast residents

BACKGROUND

Exposure to climate change-related threats (eg, hurricanes) has been associated with mental health symptoms, including post-traumatic stress symptoms. Yet it is unclear whether climate change anxiety, which is understudied in representative samples, is a specific mental health threat, action motivator, or both, particularly in populations exposed to climate-change related disasters. We sought to examine the associations between exposure to hurricanes, climate change anxiety, and climate change actions and attitudes in a representative sample of US Gulf Coast residents.

METHODS

This study used data from a 5-year, representative, prospectively assessed, probability-based, longitudinal cohort sample of residents in Texas and Florida (USA) exposed to exogenous catastrophic hurricanes rated category 3 or greater. Participants were adults aged 18 years and older and were initially recruited from the Ipsos KnowledgePanel in the 60 h before Hurricane Irma (Sept 8-11, 2017). Relationships between climate change anxiety, hurricane exposure, hurricane-related post-traumatic stress symptoms, general functional impairment, and climate change-related individual-level actions (eg, eating a plant-based diet and driving more fuel efficient cars) and collective-level actions (eg, petition signing and donating money) and climate change action attitudes were evaluated using structural equation modelling.

FINDINGS

The final survey was completed by 1479 individuals (787 [53·2%] women and 692 [46·8%] men). Two climate change anxiety subscales (cognitive-emotional impairment and perceived experience of climate change) were confirmed using confirmatory factor analysis. Mean values were low for both climate change anxiety subscales: cognitive-emotional impairment (mean 1·31 [SD 0·63], range 1-5) and perceived climate change experience (mean 1·67 [SD 0·89], range 1-5); these subscales differentially predicted outcomes. The cognitive-emotional impairment subscale did not significantly correlate with actions or attitudes; its relationship with general functional impairment was attenuated by co-occurring hurricane-related post-traumatic stress symptoms, which were highly correlated with general functional impairment in all three models (all p<0·0001). The perceived climate change experience subscale correlated with climate change attitudes (b=0·57, 95% CI 0·47-0·66; p<0·0001), individual-level actions (b=0·34, 0·21-0·47; p<0·0001), and collective-level actions (b=0·22, 0·10-0·33; p=0·0002), but was not significantly associated with general functional impairment in any of the final models. Hurricane exposure correlated with climate change-related individual-level (b=0·26, 0·10-0·42; p=0·0011) and collective-level (b=0·41, 0·26-0·56; p<0·0001) actions.

INTERPRETATION

Expanded treatment for post-traumatic stress symptoms after disasters could help address climate change-related psychological distress; experiences with climate change and natural hazards could be inflection points to motivate action.

FUNDING

National Science Foundation and the National Center for Atmospheric Research.

Development and Validation of an Individual Socioeconomic Deprivation Index (ISDI) in the NIH's All of Us Data Network

Many of the existing composite social determinant of health indices, such as Area Deprivation Index, are constrained by their reliance on geographic approximations and American Community Survey data. This study builds on the body of literature around deprivation indices to construct an individual socioeconomic deprivation index (ISDI) within the NIH's All of Us Data Network by using weighted multiple correspondence analysis on SDOH data elements collected at the participant level. In this study, the correlation between ISDI and another area-approximated index is assessed to the extent possible, along with the changes in an AI models performance due to stratified sampling based on ISDI quintiles. Individual level deprivation indices may have a wide range of utility particularly in the context of precision medicine in both centralized and distributed data networks.

Mapping Cumulative Risk in Delaware: Approach and Implications for Health Equity

BACKGROUND

Addressing health equity requires attention to upstream determinants of health, including environmental and social factors that act in tandem to increase communities' exposure to and vulnerability to toxicants. Cumulative risk assessment, which evaluates combined risks from environmental and social factors, is a useful approach for estimating potential drivers of health disparities. We developed a cumulative risk score of multiple indices of environmental and social conditions and assessed block group-level differences in New Castle County, Delaware.

METHODS

This cross-sectional study used choropleth maps to visualize the distribution of environmental, social, and cumulative risks and Moran's I statistics to assess spatial clustering of cumulative risk across the county and among individual block groups.

RESULTS

Findings indicate that environmental risk rarely occurs without social risk and that environmental and social risks co-occur in distinct areas, resulting in large-scale clustering of cumulative risk. Areas of higher cumulative risk had more Black residents and people of lower socioeconomic status.

CONCLUSIONS

Replicable measures of cumulative risk can show how environmental and social risks are inequitably distributed by race and socioeconomic status, as seen here in New Castle County. Such measures can support upstream approaches to reduce health disparities resulting from histories of environmental racism.

Variation in Hospital Mortality After Complex Cancer Surgery: Patient, Volume, Hospital or Social Determinants?

INTRODUCTION

We sought to define the individual contributions of patient characteristics (PCs), hospital characteristics (HCs), case volume (CV), and social determinants of health (SDoH) on in-hospital mortality (IHM) after complex cancer surgery.

METHODS

The California Department of Health Care Access and Information database identified patients who underwent esophagectomy (ES), pneumonectomy (PN), pancreatectomy (PD), or proctectomy (PR) for a malignant diagnosis between 2010 and 2020. Multi-level multivariable regression was performed to assess the proportion of variance explained by PCs, HCs, CV and SDoH on IHM.

RESULTS

A total of 52,838 patients underwent cancer surgery (ES: n = 2,700, 5.1%; PN: n = 30,822, 58.3%; PD: n = 7530, 14.3%; PR: n = 11,786, 22.3%) across 294 hospitals. The IHM for the overall cohort was 1.7% and varied from 4.4% for ES to 0.8% for PR. On multivariable regression, PCs contributed the most to the variance in IHM (overall: 32.0%; ES: 21.6%; PN: 28.0%; PD: 20.3%; PR: 39.9%). Among the overall cohort, CV contributed 2.4%, HCs contributed 1.3%, and SDoH contributed 1.2% to the variation in IHM. CV was the second highest contributor to IHM among ES (5.3%), PN (5.3%), and PD (5.9%); however, HCs were a more important contributor among patients who underwent PR (8.0%). The unexplained variance in IHM was highest among ES (72.4%), followed by the PD (67.5%) and PN (64.6%) patient groups.

CONCLUSIONS

PCs are the greatest underlying contributor to variations in IHM following cancer surgery. These data highlight the need to focus on optimizing patients and exploring unexplained sources of IHM to improve quality of surgical care.

Why location matters: associations between county-level characteristics and availability of National Cancer Oncology Research Program and National Cancer Institute sites

BACKGROUND

The majority of patients with cancer seek care at community oncology sites; however, most clinical trials are available at National Cancer Institute (NCI)-designated sites. Although the NCI National Cancer Oncology Research Program (NCORP) was designed to address this problem, little is known about the county-level characteristics of NCORP site locations.

METHODS

This cross-sectional analysis determined the association between availability of NCORP or NCI sites and county-level characteristic theme percentile scores from the Center for Disease Control and Prevention's Social Vulnerability Index themes. Health Resources and Services Administration's Area Health Resource Files were used to determine contiguous counties. We estimated risk ratios and 95% confidence intervals (CIs) using modified Poisson regression models to evaluate the association between county-level characteristics and site availability within singular and singular and contiguous counties.

RESULTS

Of 3141 included counties, 14% had an NCORP, 2% had an NCI, and 1% had both sites. Among singular counties, for a standard deviation increase in the racial and ethnic theme score, there was a 22% higher likelihood of NCORP site availability (95% CI = 1.10 to 1.36); for a standard deviation increase in the socioeconomic status theme score, there was a 24% lower likelihood of NCORP site availability (95% CI = 0.67 to 0.87). Associations were of smaller magnitude when including contiguous counties. NCI sites were located in more vulnerable counties.

CONCLUSIONS

NCORP sites were more often in racially diverse counties and less often in socioeconomically vulnerable counties. Research is needed to understand how clinical trial representation will increase if NCORP sites strategically increase their locations in more vulnerable counties.

Comparison of geographical and individual deprivation index to assess the risk of Sars-CoV-2 infection and disease severity: a retrospective cohort study

BACKGROUND

It has been shown that COVID-19 affects people at socioeconomic disadvantage more strongly. Previous studies investigating the association between geographical deprivation and COVID-19 outcomes in Italy reported no differences in case-hospitalisation and case-fatality. The objective of this research was to compare the usefulness of the geographic and individual deprivation index (DI) in assessing the associations between individuals' deprivation and risk of Sars-CoV-2 infection and disease severity in the Apulia region from February to December 2020.

METHODS

This was a retrospective cohort study. Participants included individuals tested for SARS-CoV-2 infection during the study period. The individual DI was calculated employing polychoric principal component analysis on four census variables. Multilevel logistic models were used to test associations between COVID-19 outcomes and individual DI, geographical DI, and their interaction.

RESULTS

In the study period, 139,807 individuals were tested for COVID-19 and 56,475 (43.5%) tested positive. Among those positive, 7902 (14.0%) have been hospitalised and 2215 (4.2%) died. During the first epidemic wave, according the analysis done with the individual DI, there was a significant inversely proportional trend between the DI and the risk of testing positive. No associations were found between COVID-19 outcomes and geographic DI. During the second wave, associations were found between COVID-19 outcomes and individual DI. No associations were found between the geographic DI and the risk of hospitalisation and death. During both waves, there were no association between COVID-19 outcomes and the interaction between individual and geographical DI.

CONCLUSIONS

Evidence from this study shows that COVID-19 pandemic has been experienced unequally with a greater burden among the most disadvantaged communities. The results of this study remind us to be cautious about using geographical DI as a proxy of individual social disadvantage because may lead to inaccurate assessments. The geographical DI is often used due to a lack of individual data. However, on the determinants of health and health inequalities, monitoring has to have a central focus. Health inequalities monitoring provides evidence on who is being left behind and informs equity-oriented policies, programmes and practices. Future research and data collection should focus on improving surveillance systems by integrating individual measures of inequalities into national health information systems.

The intersection of adverse childhood experiences and neighborhood determinants of health: An exploratory spatial analysis

OBJECTIVE

Adverse childhood experiences (ACEs) are associated with elevated risk for poor physical and psychological health outcomes. Nearly all of the literature on the association between ACEs and poor health focuses on the individual and family level; the potential role of neighborhood environment is overlooked. Understanding the relationship between ACEs and characteristics of the neighborhood environment is a necessary first step in determining if and how place-based, trauma-informed interventions might mitigate the negative effects of ACEs. The purpose of this exploratory study was to describe the neighborhood environment of adults who have experienced ≥ 4 versus ≤ 3 ACEs.

METHOD

An exploratory secondary analysis of cross-sectional and geospatial data was conducted during 2021. Data sources included 2011/2012 Philadelphia ACE Survey data, a telephone survey of 1,784 randomly sampled Philadelphia adults, linked with geospatial data on 21 neighborhood-level determinants of health. Neighborhood was defined as participant's home census tract at the time of survey. The sample for this secondary analysis included the 1,679 Philadelphia ACE Survey participants for whom home census tract was available. Bivariate logistic regression examined differences between groups (≤ 3 ACEs vs. ≥ 4 ACEs).

RESULTS

Individuals with ≥ 4 ACEs lived in neighborhoods with higher neighborhood poverty rates, less socioeconomic resources, worse food access, poorer perceived physical and mental health, more substance overdose deaths, higher crime, and less green space.

CONCLUSIONS

Findings suggest future work may benefit from considering neighborhood environments when examining and intervening upon the association between ACEs and poor physical and psychological health. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Association of Racial and Economic Privilege on Postoperative Outcomes Among Medicare Beneficiaries

INTRODUCTION

Social determinants of health can play an important role in patient health. Privilege is a right, benefit, advantage, or opportunity that can positively affect all social determinants of health. We sought to assess variations in the prevalence of privilege among patient populations and define the association of privilege on postoperative surgical outcomes.

METHODS

Medicare beneficiaries who underwent elective coronary artery bypass grafting, abdominal aortic aneurysm repair, total hip arthroplasty, total knee arthroplasty, colectomy, and lung resection were identified. The Index of Concentration of Extremes (ICE), a validated metric of both social spatial polarization and privilege was calculated and merged with county-level data obtained from the American Community Survey. Textbook outcome (TO) was defined as absence of postoperative complications, extended length of stay, 90-day mortality, and 90-day readmission. Multivariable regression analysis was performed to assess the relationship between ICE and TO.

RESULTS

Among 1,885,889 Medicare beneficiaries who met inclusion criteria, 655,980 (34.8%) individuals resided in areas with the highest privilege (i.e., White, high-income homogeneity), whereas 221,314 (11.7%) individuals resided in areas of the lowest privilege (i.e., Black, low-income homogeneity). The overall incidence of TO was 66.2% (n = 1,247,558). On multivariable regression, residence in the most advantaged neighbourhoods was associated with a lower chance of surgical complications (odds ratio [OR] 0.90, 95% confidence interval [CI] 0.88-0.91), a prolonged length of stay (OR 0.81, 95% CI 0.79-82), 90-day readmission (OR 0.94, 95% CI 0.92-0.95), and 90-day mortality (OR 0.71, 95% CI 0.68-0.74) (all P < 0.001). Residence in the most privileged areas was associated with 19% increased odds of achieving TO (OR 1.19, 95% CI 1.18-1.21), as well as a 6% reduction in Medicare expenditures versus individuals in the least privileged counties (OR 0.94, 95% CI 0.94-0.94) (both P < 0.001).

CONCLUSIONS

Privilege, based on the ICE joint measure of racial/ethnic and economic spatial concentration, was strongly associated with the likelihood to achieve an "optimal" TO following surgery. As healthcare is a basic human right, privilege should not be associated with disparities in surgical care.

Does Neighborhood Social Cohesion Influence Participation in Routine Cancer Screening? Findings From a Representative Sample of Adults in South Florida

BACKGROUND AND OBJECTIVES

Neighborhood social cohesion (NSC) has been associated with a variety of health outcomes, but limited research has examined its impact on behaviors that support cancer control. The purpose of this study was to examine associations between NSC and guideline-concordant breast, cervical and colorectal cancer screening.

METHODS

Data are from a cross-sectional survey administered to 716 adults in South Florida from 2019 to 2020. The analytic samples included adults eligible for breast (n = 134), cervical (n = 195), and colorectal cancer (n = 265) screening. NSC was measured using a validated 5-item instrument. Associations between NSC and guideline-concordant screening were examined using multivariable logistic regression.

RESULTS

In fully adjusted analyses, the odds of guideline-concordant breast cancer screening increased by 86% for every unit increase in NSC (aOR = 1.86; 95% CI, 1.03-3.36). NSC was not statistically significantly associated with guideline-concordant cervical cancer screening (aOR = 0.86; 95% CI, 0.54-1.38) or colorectal cancer screening (aOR = 1.29; 95% CI, 0.81-2.04).

CONCLUSIONS

These findings suggest that NSC supports some screening behaviors, namely, mammography use. To better understand heterogeneous relationships between NSC and utilization of preventive care services such as cancer screening, more research is needed that disaggregates effects by sex, age, race/ethnicity, and socioeconomic status.

Exploring Gender Moderation: The Impact of Neighborhood Factors on Adolescent Internalizing and Externalizing Symptoms

Limited previous studies investigated the influences of various types of neighborhood factors on adolescent behavior problems. Meanwhile, although previous theoretical frameworks suggested that gender played a significant role in terms of neighborhood impacts on adolescent behavioral problems, few studies investigated the gender differences in such neighborhood influences. Using the year 9 and year 15 data of the national dataset Future of Families and Child Wellbeing Study (FFCWS, overly sampled participants from low-income families), this study examined how the neighborhood structural and process factors can affect adolescent behavioral problems (internalizing and externalizing symptoms) and whether gender worked as a significant moderator for such relationships in the U.S. Structural equation models and multigroup SEM were estimated (N = 3411). Findings suggested that residential instability was associated with increased levels of internalizing symptoms among adolescents at age 15, whereas neighborhood social cohesion was linked to reduced levels of externalizing symptoms throughout adolescence. Furthermore, the moderating effects of gender were found for the association between residential instability and internalizing symptoms. Implications of such findings are further discussed.