Association Of Neighborhood Socioeconomic Status Research Articles

Low neighborhood socioeconomic status is associated with poor outcomes in young adults with colorectal cancer

BackgroundThe incidence of early-onset colorectal cancer has increased markedly over the past decade. Although established for older adults, there are limited data on socioeconomic and racial disparities in screening, treatment, and outcomes in this distinct group. MethodsAdults with primary colorectal cancer diagnosed at age <50 were identified from the Surveillance, Epidemiology, and End Results database. The exposure of interest was neighborhood socioeconomic status based on the Yost Index, a census-tract level composite score of neighborhood economic health. Univariate analysis was performed with χ2 analyses. Logistic regression models were created to evaluate the association of neighborhood socioeconomic status (Yost Index quintile) with metastasis at presentation and surgical intervention. Kaplan–Meier and Cox proportional hazards models were created. ResultsIn total, 45,660 early-onset colorectal cancer patients were identified; 16.8% (7,679) were in the lowest quintile of neighborhood socioeconomic status. Patients with the lowest neighborhood socioeconomic status were 1.13 times (95% confidence interval 1.06–1.21) more likely to present with metastases and had lower survival (hazard ratio 1.45, 95% confidence interval 1.37–1.53) compared to those with the highest neighborhood socioeconomic status. Non-Hispanic Black patients were more likely to present with metastatic disease (odds ratio 1.11, 95% confidence interval 1.05–1.19), less likely to undergo surgery for localized or regional disease (odds ratio 0.48, 95% confidence interval 0.43–0.53), and had lower survival (hazard ratio 1.21, 95% confidence interval 1.15–1.27) than non-Hispanic White patients. ConclusionSocioeconomic and racial disparities in early-onset colorectal cancer span diagnosis, treatment, and survival. As the disease burden of early-age onset colorectal cancer increases, interventions to boost early diagnosis and access to surgery are necessary to improve survival among minorities and patients with low neighborhood socioeconomic status.

Association of neighborhood socioeconomic status with echocardiographic parameters and re-admission following transcatheter aortic valve replacement.

Data on predictors of poor hemodynamic presentation and rehospitalizations following transcatheter aortic valve replacement (TAVR) are limited. We evaluate the association between neighborhood socioeconomic status (NSES) on echocardiographic presentation and post-TAVR readmission at a high-volume institution. All patients undergoing TAVR at a single institution between 2012 and 2022 were included. Patient addresses, baseline variables including Society of Thoracic Surgeons (STS) preoperative risk of mortality and frailty, and post-procedural outcomes were extracted from electronic health records. Using a validated US Census Bureau Index, the NSES of each patient (1-100) was tabulated, with lower values correlating to increased social deprivation. Patients were separated into four ranked groups based on NSES (rank 1: 1-25, rank 4: 76-100). Multivariable regression was performed to determine variables associated with number of days hospitalized in one-year following index TAVR procedure. A total of 2031 patients were included. The median NSES was 68 (IQR: 53-80). There was a total of 232 (11.4%) readmissions. The median number of days hospitalized in one year following TAVR was 4 (interquartile range [IQR]: 2-7) After adjusting for baseline variables including STS risk score and patient frailty, compared to patients in the lowest ranked socioeconomic group, patients of higher NSES were associated with lower aortic valve gradients at baselines (Exp[β]=0.997, 95% CI: 0.993-0.999, P=0.049). Additionally, compared to patients in the lowest ranked socioeconomic group, patients of NSES were associated with shorter duration of readmission after risk-factor adjustments (Exp[β]=0.996, 95% CI: 0.992-0.999, P=0.032). Patients of lower socioeconomic status are associated with higher aortic valve gradient at baseline and more days hospitalized in the first year after their index TAVR procedure after adjusting for other risk factors. As TAVR volume continues to expand, physicians and health systems must consider this independent factor when determining patient prognosis and readmission policies.

Association of Neighborhood Socioeconomic Status With Withdrawal of Life-Sustaining Therapies After Intracerebral Hemorrhage.

Mortality after intracerebral hemorrhage (ICH) is common. Neighborhood socioeconomic status (nSES) is an important social determinant of health (SDoH) that can affect clinical outcome. We hypothesize that SDoH, including nSES, contribute to differences in withdrawal of life-sustaining therapies (WLSTs) and mortality in patients with ICH. We performed a retrospective study of patients with ICH at 3 tertiary care hospitals between January 2017 and December 2022 identified through the Get with the Guidelines Database. We collected data on age, clinical severity, race/ethnicity, median household income, insurance, marital status, religion, mortality before discharge, and WLST from the electronic medical record. We assessed for associations between SDoH and WLST, mortality, and poor discharge mRS using Mann-Whitney U tests and χ2 tests. We performed multivariable analysis using backward stepwise logistic regression. We identified 868 patients (median age 67 [interquartile range (IQR) 55-78] years; 43% female) with ICH. Of them, 16% were Black non-Hispanic, 17% were Asian, and 15% were of Hispanic ethnicity; 50% were on Medicare and 22% on Medicaid, and the median (IQR) household income was $81,857 ($58,669-$122,078). Mortality occurred in 17% of patients, and of them, 84% of patients had WLST. Patients from zip codes with higher median household incomes had higher incidence of WLST and mortality (p < 0.01). Black non-Hispanic race was associated with lower WLST and discharge mortality (p ≤ 0.01 for both). In multivariable analysis adjusting for age and clinical severity scores, patients who lived in zip codes with high-income levels were more likely to have WLST (adjusted odds ratio [aOR] 1.88; 95% CI 1.29-2.74) and mortality before discharge (aOR 1.5; 95% CI 1.06-2.13). SDoH, including nSES, are associated with WLST after ICH. This has important implications for the care and management of patients with ICH.

The Association of Neighborhood Socioeconomic Status with Executive Function and Processing Speed in Cognitively Normal Mexican American Elders from the Health and Aging Brains Study: Health Disparities Cohort

Introduction: Neighborhood socioeconomic status (NSES) has been linked with overall health, and this study will evaluate whether NSES is cross-sectionally associated with cognition in non-Hispanic whites (NHWs) and Mexican Americans (MAs) from the Health and Aging Brain: Health Disparities Study (HABS-HD). Methods: The HABS-HD is a longitudinal study conducted at the University of North Texas Health Science Center. The final sample analyzed (n = 1,312) were 50 years or older, with unimpaired cognition, and underwent an interview, neuropsychological examination, imaging, and blood draw. NSES was measured using the national area deprivation index (ADI) percentile ranking, which considered socioeconomic variables. Executive function and processing speed were assessed by the trail making tests (A and B) and the digit-symbol substitution test, respectively. Linear regression was used to assess the association of ADI and cognitive measures. Results: MAs were younger, more likely to be female, less educated, had higher ADI scores, performed worse on trails B (all p < 0.05), and had lower prevalence of APOE4 + when compared to NHWs (p < 0.0001). A higher percentage of MAs lived in the most deprived neighborhoods than NHWs. For NHWs, ADI did not predict trails B or DSS scores, after adjusting for demographic variables and APOE4. For MAs, ADI predicted trails A, trails B, and DSS after adjusting for demographic covariates and APOE4 status. Conclusion: Our study revealed that living in an area of higher deprivation was associated with lower cognitive function in MAs but not in NHWs, which is important to consider in future interventions to slow cognitive decline.

The association of neighborhood socioeconomic status, cognition, cardiovascular risk factors, and vascular risk biomarkers in the HABS‐HD study

AbstractBackgroundNeighborhood socioeconomic status (NSES) is linked to poorer cognition and physical health, influencing the risk of cardiovascular disease and mortality. Adverse neighborhood conditions have been also associated with higher cardiovascular biomarker levels. This study goal is to examine whether NSES is associated with cognitive function and whether this relationship is explained by associations between NSES and cardiovascular risk and biomarker factors in a sample of non‐Hispanic Whites (NHW) and Mexican American (MA) elders.MethodWe studied 1391 subjects from the Health and Aging Brain Study (HABS‐HD) with signed consent, fasting blood samples, 3T MRI, clinical evaluation, and cognitive testing. Area deprivation index (ADI) was used as a measure NSES. Cardiovascular risk factors (CVRF) were ascertained by self‐ report and medical history, and biomarkers were assayed via a multiple‐plex biomarker assay platform using electrochemiluminescence. Three linear regression models examined the association of ADI with cognitive performance, adjusting for age, sex, and education, CVRF, and vascular risk biomarkers.ResultSixty percent of the sample were female. MA were significantly younger, less educated, and had higher ADI scores than NHW. They also had lower scores in global cognition and executive function measures. MA had a higher prevalence of hypertension, diabetes and obesity (p = &lt;0.0001). After controlling for demographic variables, ADI was associated with SEVLT [NHW (B = ‐0.003, t = ‐2.18, p = 0.02); MA (B = ‐0.005, t = ‐2.96, p = 0.003)] and Trails B [NHW (B = ‐0.006, t = ‐2.55, p = 0.01); MA (B = ‐0.01, t = ‐3.76, p = &lt;0.001)] scores in both ethnic groups. Dyslipidemia influenced the association of ADI with SEVLT in MA, while obesity influenced the association of ADI and trails B in NHW. The association of ADI and trails B was partially influenced by IL6 in MA, and this association was partially influenced by TNF, CRP, and VCAM values in NHW.ConclusionNSES may influence cognitive functioning. This relationship is only partially explained by CVRF and vascular blood biomarkers. Future research is needed on the longitudinal relationships of NSES, cognitive impairment, and vascular factors.

Cross-sectional association between neighborhood socioeconomic status and sleep duration among Black and white men and women: The Southern Community Cohort Study

ObjectiveTo examine the association of neighborhood socioeconomic status (SES) with sleep duration among a large cohort of Black and white men and women in the United States. MethodsWe used data from the Southern Community Cohort Study (SCCS, N = 75,248). Neighborhood SES was based on census data and sleep duration was measured by self-report. Multinomial logistic regression analysis was performed to assess the association between neighborhood SES and short (<7 hours) and long (≥9 hours) sleep in the overall sample and according to race–sex subgroups. ResultsIn the total sample, when compared with the highest quintile of neighborhood SES, the lowest quintile was associated with higher odds of both short (adjusted ORQ5 vs. Q1 [95% CI], 1.10 [1.03, 1.17]) and long sleep (1.37 [1.24, 1.52]). In race–sex specific analysis, the association between lower neighborhood SES and short sleep was only observed among white women (1.21 [1.05, 1.40]), but not in other subgroups. On the other hand, the association between lower neighborhood SES and long sleep duration was primarily observed among Black women (1.31 [1.06, 1.60]). ConclusionsThe association between neighborhood SES and sleep duration varied among race-and-sex subgroups. These findings provide new evidence on the importance of considering individual sociodemographic characteristics in understanding the potential effects of neighborhood socioeconomic context on sleep health.

Neighbourhood socio-economic status and positive affectivity among older residents in Germany: a cross-sectional analysis with data from the Heinz Nixdorf Recall Study

BackgroundPhysical and social neighbourhood characteristics can vary according to the neighbourhood socio-economic status (SES) and influence residents’ perceptions, behaviours and health outcomes both positively and negatively. Neighbourhood SES has been shown to be predictive of mental health, which is relevant for healthy ageing and prevention of dementia or depression. Positive affectivity (PA) is an established indicator of mental health and might indicate a positive emotional response to neighbourhood characteristics. In this study, we focussed on the association of neighbourhood SES with PA among older residents in Germany and considered social integration and environmental perceptions in this association.MethodsWe used questionnaire-based data of the ongoing population-based Heinz Nixdorf Recall Study for our cross-sectional analysis, complemented by secondary data on social welfare rates in the neighbourhood of residents’ address. PA was assessed using the Positive and Negative Affect Schedule (PANAS) in 2016. Linear regression models were performed to estimate the associations and adjusted for socio-demographic variables.ResultsHigher social welfare rates were associated with lower PA scores. The strongest negative association from the crude model (b = −1.916, 95%-CI [−2.997, −0.835]) was reduced after controlling for socio-demographic variables (b = −1.429, 95%-CI [−2.511, −0.346]). Social integration factors (b = −1.199, 95%-CI [−2.276, −0.121]) and perceived environmental factors (b = −0.875, 95%-CI [−1.971, 0.221]) additionally diminished the association of social welfare rates with PA in the full model (b = −0.945, 95%-CI [−2.037, 0.147]).ConclusionOur results suggest that neighbourhoods have an influence on the occurrence and the extent of PA. Public health interventions that address socio-economic disadvantage in the neighbourhood environment could be an effective and far-reaching way to reduce the risk of depression and depressive symptoms due to low PA in older residents.

Role of neighbourhood social characteristics in children’s use of mental health services between ages 9 and 13 years: a population-based cohort study in the Netherlands

ObjectivesThis study aims to investigate the association of neighbourhood socioeconomic status (SES) and social cohesion (SC) within the neighbourhood with mental health service use in children, independent of individual-level characteristics...

Neighborhood-Level Inequalities in Dental Care of Adolescents and Young Adults in Southwestern Ontario

We examined whether the association of neighborhood-level socioeconomic status (SES) with the cost of dental care and dental care outcomes differs between adolescents and young adults. A total of 2915 patient records were split into two groups: adolescents (15 to 17 years of age) and young adults (18 to 24 years of age). Three dental care outcomes—routine oral evaluation (OEV-CH-A), utilization of preventive services (PRV-CH-A), and dental treatment services (TRT-CH-A)—were determined according to the Dental Quality Alliance (DQA) criteria. Associations of neighborhood SES and other sociodemographic variables with dental care outcomes and the cost of dental care were assessed using binary logistic and univariate linear regression models, respectively. Young adults had significantly lower PRV-CH-A and higher TRT-CH-A scores when compared to adolescents. We observed a significant negative association between TRT-CH-A and median household income in both adolescents and young adults. Utilization of dental treatment services was positively associated with the cost of care in both age groups, whereas utilization of preventive services was inversely associated with the cost of care in young adults, but not in adolescents. Neighborhood-level income was inversely associated with increased TRT-CH-A in both young adults and adolescents. In summary, young adults showed significantly worse preventive and treatment outcomes when compared to adolescents. Moreover, individuals from neighborhoods with a lower household income showed a significantly higher cost of dental care, yet worse treatment outcomes.

Abstract 784: Association of neighborhood socioeconomic status and aggressive non-small cell lung cancer biology

Abstract Introduction: Lung cancer is the leading cause of cancer-related deaths in the US. While smoking remains the most common cause for non-small cell lung cancer (NSCLC), less research exists on the role of adverse social conditions and neighborhood socioeconomic status (nSES) in the development of specific NSCLC somatic mutations. Neighborhood conditions can be influenced by economic, housing, education, transportation, and environmental factors. Understanding the relationship between NSCLC biology and nSES is vital in addressing disproportionately high rates of NSCLC incidence and poor outcomes among marginalized communities in the US. While neighborhood deprivation indices have been linked to aggressive biology in other cancers, the link to somatic mutations in NSCLC is unknown. The purpose of this analysis is to identify relationships between exposure to adverse nSES conditions and somatic KRAS mutations, a marker of aggressive NSCLC biology. Methods: We analyzed NSCLC patients who received care at the City of Hope Comprehensive Cancer Center in Duarte, CA from 2015-2018 and received somatic KRAS testing of their lung tumor tissue as a part of their care. The patients' medical record was abstracted for data including demographics and disease characteristics. The patients' home address was geocoded and assigned a census tract-level exposure to several indices of nSES conditions including the California Health Places Index (HPI), the US Department of Housing and Urban Development Labor Market Engagement Index (LME), and the Area Deprivation Index (ADI). We used several logistic regressions to model the presence of somatic KRAS mutations in relation to exposure to various adverse nSES conditions. Odds ratios (ORs) were adjusted for age at diagnosis, sex, cigarette smoking, race/ethnicity, insurance status, cancer stage, cancer histology, and exposure to PM2.5. Results: Of 426 eligible NSCLC patients, 28% tested positive for a KRAS mutation, 54% were non-Hispanic White, 66% were stage IV, and 83% had adenocarcinomas. The risk of a KRAS mutation was significantly elevated among patients living in places with lower HPI scores (OR 1.92, 95% CI: 1.11 - 3.32) and lower LME (OR 1.16, 95% CI: 1.05 - 1.28). In adjusted models, PM2.5, ADI, and other nSES indices were not significantly associated with risk of a KRAS mutation. Conclusions: We found that NSCLC patients living in deprived neighborhood conditions as measured by the California HPI and LME were more likely to have a somatic KRAS mutation. This relationship shows that nSES may be an important determinant of aggressive NSCLC biology. However, our results also indicate that deprivation is a complex mixture of domains and regionally specific influences. These findings indicate that future research may need to consider locally specific nSES measures as a dynamic marker of neighborhood conditions in addition to nationally derived indexes such as the ADI. Citation Format: Sam Wing, Ernesto Sosa, Tarik Benmarhnia, Jiue-An Yang, Stacy Gray, Marta Jankowska, Loretta Erhunmwunsee. Association of neighborhood socioeconomic status and aggressive non-small cell lung cancer biology [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 784.

Association of Neighborhood Socioeconomic Status With Outcomes in Patients Surviving Stroke

To examine associations between neighborhood socioeconomic status (nSES) and 90-day poststroke outcomes. The Brain Attack Surveillance in Corpus Christi Project is a population-based surveillance study in Nueces County, Texas. Patients with strokes were identified between 2010 and 2016 via active and passive surveillance and enrolled in the study. nSES index is a standardized composite of 2010 Census tract-level income, wealth, education, and employment (median -4.56, interquartile range -7.48 to -0.46). The 90-day outcomes were ascertained via interview: functional status measured by the average of 22 activities of daily living/instrumental activities of daily living (range 1-4), biopsychosocial health by the Stroke-Specific Quality of Life scale (range 0-5), and depressive symptoms by the 8-item Patient Health Questionnaire (range 0-24). Associations between nSES and outcomes were estimated using confounder-adjusted generalized estimating equations with an nSES × NIH Stroke Scale score interaction term. Seven hundred seventy-six survivors made up the analytical sample (52.96% male, 62.24% Mexican American, 52.96% ≥64 years old). Higher compared to lower nSES (mean difference comparing 75th to 25th percentile of nSES) was associated with better function (-0.27, 95% confidence interval [CI] -0.49 to -0.05), better biopsychosocial health (0.26, 95% CI 0.06-0.47), and fewer depressive symptoms (-1.77, 95% CI -3.306 to -0.48) among those with moderate to severe strokes. Among those with minor strokes, higher nSES was associated with better function (-0.13, 95% CI -0.24 to -0.02). nSES may influence poststroke recovery. Studies should identify neighborhood characteristics that contribute to poststroke outcomes, particularly in moderate to severe stroke survivors.

Neighborhood Socioeconomic Status and Quality of Kidney Care: Data From Electronic Health Records

Rational & ObjectiveElectronic health records can be leveraged to assess quality-of-care measures in patients with chronic kidney disease (CKD). Neighborhood socioeconomic status could be a potential barrier to receiving appropriate evidence-based therapy and follow-up. We examined whether neighborhood socioeconomic status is independently associated with quality of care received by patients with CKD.Study DesignObservational study using electronic health record data.Setting & ParticipantsRetrospective study of patients seen at a health care system in the 7-county Minneapolis/St Paul area.ExposuresCensus tract socioeconomic status measures (wealth, income, and education).OutcomesIndicators of CKD quality of care: (1) prescription for angiotensin-converting enzyme inhibitor/angiotensin receptor blocker in patients with stage ≥ 3 CKD or stage 1 or 2 CKD with urinary albumin-creatinine ratio (UACR) > 300 mg/d, (2) UACR measurement among patients with laboratory-based CKD (estimated glomerular filtration rate < 60 mL/min/1.72 m2), and (3) CKD identified on the problem list or coded for at an encounter among patients with laboratory-based CKD.Analytic ApproachMultilevel Poisson regression with robust error variance with a random intercept at the census tract level.ResultsOf the 16,776 patients who should be receiving an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, 65% were prescribed these medications. Among patients with laboratory-based CKD (n = 25,097), UACR was measured in 27% and CKD was identified in the electronic health record in 55%. We found no independent association between any neighborhood socioeconomic status measures and CKD quality-of-care indicators.Limitations1 health care system and selection bias.ConclusionsWe found no association of neighborhood socioeconomic status with quality of CKD care in our cohort. However, adherence to CKD guidelines is low, indicating an opportunity to improve care for all patients regardless of neighborhood socioeconomic status.

AT THE INTERFACE OF THE BRAIN AND ENVIRONMENT: DETERMINANTS OF COGNITIVE FUNCTION AND MOBILITY

It is hypothesized that older adults are more influenced by environmental factors due to reduced tolerance to stressors and greater cumulative exposure. The role of environmental factors in brain and cognitive aging, specifically, has not been well studied. In this symposium, we highlight novel work at the interface of the environment and the brain in aging. The presentations assess varying aspects of the environment/brain interface within three cohorts. Two of the presentations focus on the environment as a risk factor for brain or cognitive aging. Sara Godina will present analyses of neighborhood socioeconomic status and neuroimaging markers of brain atrophy within the Health ABC Study, with the aim of understanding documented associations of neighborhood socioeconomic status with cognitive function. Jessica Finlay will present data from the REGARDS study linking weather conditions with cognitive changes. Climate influences social and physical activities and could thereby, impact cognitive aging. The brain also serves to process and integrate environmental data in order to direct behaviors in an adaptive manner. Two of the presentations assess how cognitive aging may impact individuals’ interactions with the environment. Using residential histories of participants in the Cardiovascular Health Study, Jonathan Platt will explore how cognitive trajectories change in relation to changes in residence. These analyses will demonstrate how residential changes may be either supportive or detrimental to cognitive aging. Finally, Andrea Rosso will present data from the Health ABC that demonstrates how cognitive aging may determine the vulnerability of older individuals to environmental influences on mobility declines.

Neighbourhood socioeconomic status and overweight/obesity: a systematic review and meta-analysis of epidemiological studies

ObjectiveLow neighbourhood socioeconomic status (NSES) has been linked to a higher risk of overweight/obesity, irrespective of the individual’s own socioeconomic status. No meta-analysis study has been done on the association....

Longitudinal associations of neighborhood socioeconomic status with cardiovascular risk factors: A 46-year follow-up study

ObjectivesNeighborhood characteristics are increasingly recognized as important determinants of cardiovascular disease (CVD) risk. However, longitudinal studies on the health impacts of neighborhood characteristics are rare. We sought to investigate whether neighborhood socioeconomic status (NSES) during birth, childhood and adulthood is associated with CVD risk factors in adulthood. MethodsUsing longitudinal data from the New England Family Study (n = 671) with 46-years of follow-up, participants' home addresses were geocoded at birth (mean age = 1.6 months), childhood (mean age = 7.1 years), and adulthood (mean age = 44.2 years) across Massachusetts and Rhode Island in the US from 1961 to 2007. We used multilevel models to evaluate associations of NSES across the life-course with systolic blood pressure, diastolic blood pressure and body mass index (BMI) in adulthood, adjusting for age, sex, race/ethnicity, mother's race, individual SES, and parental SES. ResultsIn fully adjusted models, one standard deviation higher NSES at birth was associated with a 1.9 mmHg lower SBP (95% CI: 3.8, −0.1) and 1.3 mmHg lower DBP (95%CI: 2.6,-0.03) in adulthood; while one standard deviation of higher NSES at adulthood was associated with 0.87 kg/m2 lower BMI (95%CI: 1.7, −0.1). ConclusionsWe found that living in a socioeconomically disadvantaged neighborhood early in life and in adulthood was associated with blood pressure and BMI, respectively, two established risk factors for CVD. Our findings support a longitudinal association between exposure to socioeconomically disadvantaged neighborhoods in early life and CVD risk factors in adulthood.

Impact of Socioeconomic Status on Outcomes of Patients with Kawasaki Disease

To evaluate the association of neighborhood socioeconomic status (SES) with time to intravenous immunoglobulin treatment, length of stay (LOS), and coronary artery aneurysms (CAAs) in patients with Kawasaki disease. We examined the relationship of SES in 915 patients treated at a large academic center between 2000 and 2017. Neighborhood SES was measured using a US census-based score derived from 6 measures related to income, education, and occupation. Linear and logistic regression were used to examine the association of SES with number of days of fever at time of treatment, LOS, and CAA. Patients in the lowest SES quartile were treated later than patients with greater SES (7 [IQR 5, 9] vs 6 [IQR 5, 8] days, P=.01). Patients in the lowest SES quartile were more likely to be treated after 10days of illness, with an OR 1.9 (95% CI 1.3-2.8). In multivariable analysis, SES remained an independent predictor of the number of days of fever at time of treatment (P=.01). Patients in the lowest SES quartile had longer LOS than patients with greater SES (3 [IQR 2, 5] vs 3 [IQR 2, 4], P=.007). In subgroup analysis of white children, those in the lowest SES quartile vs quartiles 2-4 were more likely to develop large/giant CAA 17 (12%) vs 30 (6%), P=.03. Lower SES is associated with delayed treatment, prolonged LOS, and increased risk of large/giant CAA. Novel approaches to diagnosis and education are needed for children living in low-SES neighborhoods.

Neighborhood Environment and DNA Methylation: Implications for Cardiovascular Disease Risk.

Exposure to chronic stress such as living in disadvantaged neighborhoods has been related to cardiovascular disease (CVD). Chronic stress may increase the risk for CVD by increasing levels of systemic inflammation (e.g., higher levels of pro-inflammatory cytokines). Differential DNA methylation of inflammation-related candidate genes is also related to higher risk for CVD. Thus, the purpose of this review was to examine the association of neighborhood disadvantage with DNA methylation. A search of literature was conducted using Scopus, CINAHL, PubMed, Medline, and Embase databases. The keywords neighborhood, neighborhood disorder, neighborhood crime, neighborhood violence, neighborhood safety, built environment, and housing vacancy were combined with the keywords DNA methylation and epigenetics. Five studies were included in this review (n = 3 adult blood samples and n = 2 fetal blood samples). Four of the five studies reported an association of neighborhood socioeconomic status, social environment, and crime with either global or gene-specific DNA methylation. Only two studies examined the association of neighborhood disadvantage with inflammation-related candidate genes. One of these studies found a significant association of neighborhood socioeconomic disadvantage and social environment with DNA methylation in inflammation-related candidate genes. Thus, data are limited on the association between neighborhood disadvantage and DNA methylation of inflammation-related candidate genes, as well as genes in other potential mechanistic pathways including psychosocial stress, toxin response, and adiposity. Future studies should examine these associations and the potential epigenetic mechanisms by which neighborhood disadvantage increases the risk for CVD.

Association of neighbourhood socioeconomic status and diabetes burden using electronic health records in Madrid (Spain): the HeartHealthyHoods study

ObjectiveTo study the association between neighbourhood socioeconomic status and diabetes prevalence, incidence, and control in the entire population of northeastern Madrid, Spain.SettingElectronic health records of the primary-care system in four...

Neighborhood Environments and Diabetes Risk and Control.

The objective of this review is to highlight the evidence on the association between contextual characteristics of residential environments and type 2 diabetes, to provide an overview of the methodological challenges and to outline potential topics for future research in this field. The link between neighborhood socioeconomic status or deprivation and diabetes prevalence, incidence, and control is robust and has been replicated in numerous settings, including in experimental and quasi-experimental studies. The association between characteristics of the built environment that affect physical activity, other aspects of the built environment, and diabetes risk is robust. There is also evidence for an association between food environments and diabetes risk, but some conflicting results have emerged in this area. While the evidence base on the association of neighborhood socioeconomic status and built and physical environments and diabetes is large and robust, challenges remain related to confounding due to neighborhood selection. Moreover, we also outline five paths forward for future research on the role of neighborhood environments on diabetes.

Association of Neighborhood Socioeconomic Status With Risk of Infection and Sepsis.

Prior studies suggest disparities in sepsis risk and outcomes based on place of residence. We sought to examine the association between neighborhood socioeconomic status (nSES) and hospitalization for infection and sepsis. We conducted a prospective cohort study using data from 30239 participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. nSES was defined using a score derived from census data and classified into quartiles. Infection and sepsis hospitalizations were identified over the period 2003-2012. We fit Cox proportional hazards models, reporting hazard ratios (HRs) with 95% confidence intervals (CIs) and examining mediation by participant characteristics. Over a median follow-up of 6.5 years, there were 3054 hospitalizations for serious infection. Infection incidence was lower for participants in the highest nSES quartile compared with the lowest quartile (11.7 vs 15.6 per 1000 person-years). After adjustment for demographics, comorbidities, and functional status, infection hazards were also lower for the highest quartile (HR, 0.84 [95% CI, .73-.97]), with a linear trend (P = .011). However, there was no association between nSES and sepsis at presentation among those hospitalized with infection. Physical weakness, income, and diabetes had modest mediating effects on the association of nSES with infection. Our study shows that differential infection risk may explain nSES disparities in sepsis incidence, as higher nSES is associated with lower infection hospitalization rates, but there is no association with sepsis among those hospitalized. Mediation analysis showed that nSES may influence infection hospitalization risk at least partially through physical weakness, individual income, and comorbid diabetes.