Effet du statut socio-économique du quartier de résidence sur le tabagisme dans l'étude de cohorte CARVAR 92

Introduction: Neighborhood characteristics and physical activity levels may impact physical function. The present study examined the relationship between neighborhood socioeconomic status (NSES) and functional status impairment among older men and women and examined whether this relationship differed by physical activity. Hypothesis: Compared to those with high levels of NSES, participants with low NSES will have higher odds of functional impairment in late life. This association will be modified by physical activity. Methods: We constructed an aggregate measure of NSES using census-based indicators of wealth, education, and occupation and quantified distribution-based tertiles of low, middle, and high NSES among ARIC cohort participants in Visit 5 (2011-2013). We used the Rosow-Breslau scale to ascertain functional status (range 0-4; functional impairment defined as a score<4) during the 2016 annual telephone interview. Multivariable logistic regression was used to examine the association between NSES tertiles and functional status impairment adjusting for age, race, ARIC center, and sex. We tested for effect modification by AHA-defined physical activity (categorized as poor, intermediate, ideal based on weekly minutes of moderate-to-vigorous physical activity). We also tested for effect modification by sex, race, and age. Results: Among 4,439 participants (mean age: 75 (SD 5) years, 22% Black, 55% female), 1,788 (40%) had functional status impairment. In analyses adjusted for sex, race, and age, the odds of functional impairment among participants with low NSES were 1.86 (95% CI: 1.60, 2.16) times the odds of functional impairment among those with high NSES. There was evidence of effect measure modification by race (p=0.06) and age (p=0.07). In White participants, the odds of functional status impairment among participants with low NSES was 1.99 (95% CI: 1.69, 2.35) times the odds of functional impairment among those with high NSES. This association was attenuated in Black participants (OR: 1.38, 95% CI: 0.96, 2.00). In participants less than 74 years, the odds of functional status impairment among participants with low NSES was 2.17 (95% CI: 1.73, 2.72) times the odds of functional impairment among those with high NSES. This association was attenuated in participants 74 years and older (OR: 1.64, 95% CI: 1.34, 1.99). There was no evidence of effect modification by physical activity (p=0.20) nor sex (p=0.65). Conclusions: Low NSES is modestly associated with functional status impairment in older adulthood. This association appeared stronger in Whites compared to Blacks, and in those younger than 74 years.

Associations between the built environment and emotional, social and physical indicators of early child development across high and low socioeconomic neighbourhoods

Introduction: Functional impairments influence the performance of activities of daily living and may result in dependence on others for basic self-care needs. Lower individual-level socioeconomic status (SES) is associated with more self-reported disability and lower measured walking speeds which convey a higher risk of cardiovascular and all-cause mortality. The role of neighborhood-level SES on these functional outcomes has not been widely examined. Hypothesis: We hypothesized that residing in a socioeconomically disadvantaged neighborhood is inversely associated with physical function, after accounting for individual-level SES. Methods: We included 5,388 participants (42% male, 19% black, mean age: 76 years) from the 2011-2013 examination of the ARIC cohort. Neighborhood SES was constructed from census-tract data and an index score was derived based on aggregate z-score estimates from the following 6 dimensions: median household income; median value of owner-occupied units; % adults with a high school degree; % adults with a college degree; % households receiving interest, dividend or rental income; and % adults employed in executive, managerial or professional occupations. Race-specific tertiles were generated to indicate low, middle and high neighborhood SES. The Short Physical Performance Battery (SPPB) was used to derive a summary score (0-12) of physical function based on the individual’s performance on gait speed, chair stands and balance exercises. Negative binomial regression was used to quantify the difference in the log of expected counts in the SPPB score between race-stratified low, middle and high neighborhood SES, adjusting for age, sex, body mass index (BMI), smoking, hypertension, diabetes, study center, and education as a measure of individual-level SES. The multivariable-adjusted effect of neighborhood SES on a 4-meter walking speed test and on grip strength was estimated by least-squares regression. Results: Blacks had a slower walking speed, higher grip strength and lower SPPB score compared to whites. Hypertension, higher BMI, and lower education were more prevalent among white and black individuals from low SES neighborhoods, compared to those from high SES neighborhoods. White participants residing in a low SES neighborhood had a 1.1 kilogram (95% CI: 0.3, 1.9) greater grip strength compared to those residing in high SES neighborhoods. Neighborhood SES was not associated with walking speed and SPPB in either whites or blacks. Associations were robust to adjustment for education. Conclusions: Individual but not neighborhood-level SES was associated with poorer physical function. The prevalence of adverse clinical comorbidities was higher among both black and white participants living in disadvantaged neighborhoods. Poorer individual, modifiable health and SES measures may be targets for interventions to reduce functional disparities.

Numerous studies have examined the role of socio-economic status on physical activity, obesity, and cognitive performance in youth or older adults, but few studies have examined the role of neighborhood socio-economic status (NSES) on motor or cognitive performance in kindergarten children. This study aimed to examine whether lower NSES (measured by the social data atlas) was associated with lower motor and inhibitory control performance in kindergarten children. One hundred twenty-nine preschoolers were recruited from eight kindergartens in low and high NSES areas in Stuttgart, one of Germany's largest metropolitan areas. Motor functioning (Movement Assessment Battery for Children, MABC-2; Manual Dexterity, Aiming and Catching, and Balance) and inhibitory control (Flanker Task, Go/NoGo Task) were assessed in a sample of 3- to 6-year-old children within a cross-sectional study. Children from a low NSES background showed the expected difficulties in inhibitory control and motor performance, as indicated by poorer performance than children from a high NSES background. Sex-specific analysis revealed girls from low NSES areas to have the lowest fine motor control; children with low NSES reach a Developmental Coordination Disorder at-risk status of 13% (boys and girls), in contrast to children with high SES (boys 9.1%, girls 0.0%). Motor performance and inhibitory control correlated positively with regard to the group from a low NSES background. Researchers and practitioners are advised to develop a more nuanced picture of motor and academic achievement in heterogeneous neighborhoods when designing early intervention programs, particularly with regard to sex differences, with the most significant disadvantage to girls with lower NSES.

Resilience, an individual’s ability to successfully adapt to adversity, is a multifaceted outcome that may be affected by individual and community factors. A comprehensive examination of resilience by race and neighborhood socioeconomic status (NSES) among women aged 80+ is needed to better understand longevity in diverse populations. Women aged 80+ in 2011, in the Women’s Health Initiative (WHI) study were included. Resilience was measured using the 3-item Brief Resilience Scale, with higher scores indicating better resiliency. Descriptive statistics and multivariable linear regression examined the association of demographic, psychosocial, and health variables with resilience by race (White, Black, Asian) and NSES. The majority of participants (n=29,367, median age=84.0) were non-Hispanic White (91.4%), and had multimorbidities (66%). There were no significant differences by race on mean resiliency scores (p=0.06). Mean resilience was higher among women with higher NSES (low NSES=3.94±0.83, moderate NSES=3.95±0.82, high NSES=4.00±0.81; p< 0.001). Optimism (p< 0.001), social support (p< 0.01), and physical/mental symptom burden (p< 0.05) were significant correlates of resilience among Asian, Black, and White women. Self-rated health (p< 0.001), depressive symptoms (p< 0.001), optimism (p< 0.001), social support (p< 0.001), physical/mental symptom burden (p< 0.001), and body mass index (p< 0.001) were significant correlates of resilience across women with low, moderate, and high NSES. Age was significantly associated with resilience among women with moderate (β=-0.004, p=0.019) and high NSES (β=-0.005, p=0.045). This study found several common correlates of resilience across race and NSES among women aged 80+ in the WHI. Future research to enhance resilience, such as through psychosocial and behavioral interventions, is warranted.

From street address to survival: Neighborhood socioeconomic status and pancreatic cancer outcomes

Neighborhood socioeconomic status (SES), beyond individual SES, has been associated with health behaviors and outcomes. We constructed a neighborhood SES index using readily available US Census variables and studied associations of the index with self-reported education, formal education, and neighborhood residential characteristics among adult enrollees of a managed care organization (MCO). A neighborhood SES index was constructed for MCO enrollees using a principal components analysis of 7 Census measures of their residential tracts or block groups. Quartiles of resulting neighborhood SES scores were matched with self-reported education, household income, and neighborhood residential characteristics obtained on 3 surveys of MCO adults ranging in age from 18 to 99. Cross-tabulations of neighborhood SES with self-reported measures were used to assess concordance. Consistent with other non-MCO populations, distributions of the neighborhood SES index and self-reported education, household income, and other neighborhood residential characteristics were concordant. The presence of high SES MCO enrollees in low SES neighborhoods and low SES MCO enrollees in high SES neighborhoods was, however, common. MCO enrollees living in low SES neighborhoods also reported neighborhood problems (crime, unattended dogs) known to affect walkability more frequently than those living in high SES neighborhoods. A simple, valid neighborhood SES index can be constructed for MCO populations using readily available US Census variables. Although individual and neighborhood SES are on average concordant, discrepancies between individual and neighborhood SES suggest that other factors may influence how area-based SES contributes to health behaviors and outcomes in an MCO population.

Impact of Neighborhood Socioeconomic Status on Cardiovascular Risk Factors in a French Urban Population

Neighborhood Socioeconomic Status, Health Insurance, and CKD Prevalence: Findings From a Large Health Care System

Household socioeconomic status modifies the association between neighborhood SES and obesity in a nationally representative sample of first grade children in the United States.

Living in a low socioeconomic status neighbourhood is associated with lower cumulative ongoing pregnancy rate after IVF treatment

There is an inverse relationship between individual socio-economic status (SES) and amount of occupational physical activity. The role of the socio-economic environment is, however, less clear. This study examined the independent influences of neighborhood and individual SES on absolute and relative amount of occupational physical activity. It also examined the moderating effects of neighborhood SES on the relationship between individual SES and occupational physical activity. Employees (n = 1236) resident in high or low SES neighborhoods were assessed on socio-demographic factors, including educational attainment and household income, and physical activity. Neighborhood SES and individual SES were independently inversely related to absolute and relative amount of occupational physical activity. Significant interactions between neighborhood SES and level of educational attainment in the contribution of total and vigorous occupational physical activity to total physical activity were found. Neighborhood SES can function as a moderator in the relationship between individual SES and occupational physical activity.

Among U.S. Latinas, breast cancer risk is lower among foreign-born than U.S.-born women; however, after adjustment for known risk factors, the association remained in post-menopausal women only. To evaluate the extent to which breast cancer risk among Latinas may be affected by neighborhood characteristics, we examined the independent and joint associations of individual-level (nativity, language use, generational status, percent of life in U.S.) and neighborhood-level (residence in ethnic enclave) immigration factors with breast cancer risk in 1401 Latina cases and 1074 Latina controls pooled from two population-based San Francisco Bay Area studies. Ethnic enclaves refer to areas that maintain more Latino cultural mores and are ethnically distinct from the surrounding area. Block group-level measures of socioeconomic status (SES) and ethnic enclave are based on indices comprising multiple Census 2000 measures, and developed via principal components analyses. Unconditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI), with adjustment for relevant confounders and block group clustering. Among pre-menopausal women, we identified a synergistic effect between individual- and neighborhood-level immigration factors. Compared to U.S.-born Latinas living in low ethnic enclaves (i.e., less ethnic), foreign-born Latinas in high enclaves (i.e., more ethnic) had a lower risk of breast cancer, which was attributable primarily to differences in reproductive risk factors (age at menarche, parity, breastfeeding, age at first birth), education, and neighborhood SES. There was also a synergistic effect between neighborhood SES and ethnic enclave, with the reduction in breast cancer risk greatest among women in high SES and high enclave neighborhoods [OR (95% CI) = 0.30 (0.15-0.60)] compared to women living in high SES and low enclave neighborhoods. Risk reductions were more moderate among those in low SES neighborhoods and similar across ethnic enclave status [low SES/high enclave OR = 0.64 (0.41-1.01); low SES/low enclave OR = 0.60 (0.41-0.86), compared to high SES/low enclave]. Similar patterns of synergistic effects were found among post-menopausal women. Compared to U.S.-born Latinas living in low enclaves, foreign-born Latinas in high enclaves had a considerably lower risk of breast cancer [OR (95% CI) = 0.41 (0.28-0.61)], while the moderate risk reductions among U.S.-born Latinas living in high enclaves and foreign-born in low enclaves were no longer statistically significant after adjusting for behavioral and reproductive risk factors. Neighborhood SES had a stronger effect on breast cancer risk than ethnic enclave. Compared to those living in high SES and low enclave neighborhoods, ORs were similar for low SES/low enclave [OR=0.65 (0.45-0.93)] and low SES/high enclave [OR=0.53 (0.39-0.71)]. Our results suggest that, even after accounting for individual-level factors, the SES and ethnic/acculturation level of neighborhoods play an important role in influencing breast cancer risk among Latinas. Risk among Latinas is lower in more ethnic and lower SES neighborhoods, although among pre-menopausal women, the ethnic enclave effect appears to be explained by reproductive factors. Identifying the specific aspects of these neighborhoods (e.g., more built environment, social support /networks, ethnic foods) that Latina women reside in may provide insights into breast cancer risk factors, and strategies for risk reduction. Citation Format: Scarlett Lin Gomez, Salma Shariff-Marco, Juan Yang, Meera Sangaramoorthy, Theresa H.M. Keegan, Jocelyn Koo, Clayton Schupp, Andrew Hertz, David O. Nelson, Esther M. John. Individual- and neighborhood-level immigration factors and breast cancer risk among Latinas in the San Francisco Bay Area: The Neighborhoods and Breast Cancer (NABC) Study. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B26. doi:10.1158/1538-7755.DISP13-B26

ObjectivesFew studies have explored the impact of neighbourhood socioeconomic status (SES) on health behaviours in youths in Germany. Our aim was to investigate the association of individual and neighbourhood SES...

Recent studies show an association between neighborhood-level measures of socioeconomic status (SES) and outcomes for patients with heart failure. We do not know whether neighborhood SES has a primary effect or is a marker for individual SES. We used the data from participants of the Telemonitoring to Improve Heart Failure Outcomes (Tele-HF) trial, recruited from 33 US internal medicine and cardiology practices and examined the association between neighborhood SES and outcomes of patients with heart failure. We used census tracts as proxies for neighborhoods and constructed summary SES scores that included information about wealth and income, education, and occupation. The primary end points were readmission and all-cause mortality at 6 months. We conducted patient interviews and medical chart reviews to obtain demographic information, clinical factors, therapies, and individual SES. We included 1557 patients: 524, 516, and 517 from low, medium, and high SES neighborhoods, respectively (mean age, 61.1±15.2 years; 42.2% women).Overall, 745 patients (47.8%) had ≥1 readmission and 179 patients (11.5%) died. When compared with patients in high SES neighborhoods, those living in low-SES neighborhoods were more likely to be readmitted (odds ratio, 1.35; 95% confidence interval, 1.01-1.82), but the mortality rates were not significantly different (odds ratio, 0.78; 95% confidence interval, 0.50-1.18). The results were consistent after multivariable adjustments for individual demographics, clinical factors, and individual SES. Among patients with heart failure, neighborhood SES was significantly associated with 6-month all-cause readmission even after adjusting for other patient-level factors, including individual SES. Greater number of events and longer follow-up is required to ascertain the potential effect of neighborhood SES on mortality. http://clinicaltrials.gov/. Unique identifier: NCT00303212.