Changes In Disparities Research Articles

Longitudinal Analysis of Eye Health Disparities Due to Trachoma Using Country-Level Data from the Global Burden of Disease Study 2019

ABSTRACT Purpose To assess the change in eye health disparities due to trachoma using longitudinal country-level data (1990–2019) from the global burden of disease study 2019. Methods:Statement We obtained data on the burden of trachoma and population statistics from the Global Health Data Exchange website. We assessed the geographic distribution of trachoma at the global level and World Bank regional level from year to year using Gini coefficients and statistics of inequality that ranged from 0 (total equality) to 1 (total inequality). Result We found that 60 countries and territories had a burden of trachoma, and these were from all regions except Central Europe, Eastern Europe, and Central Asia. At the global level, the Gini coefficient had increased from 0.546 to 0.637 (p for trend: <0.001) in the last three decades, while the mean disability-adjusted life years (DALYs) per 100,000 people declined from 13.0 to 3.2 (p for trend: <0.001). The inequality statistics had significantly worsened in South Asia and Sub-Saharan Africa (p for trend: <0.001) despite the decrease in the mean DALYs per capita. Conclusion Our study revealed that the burden of trachoma dramatically decreased; however, the eye health inequality due to trachoma increased globally and in two of the most endemic regions in the last three decades. Global eye health experts need to monitor the distribution of eye diseases and ensure appropriate, effective, uniform, and high-quality eye care for all.

Analyzing Child Firearm Assault Injuries by Race and Ethnicity During the COVID-19 Pandemic in 4 Major US Cities

This cross-sectional study examines changes in rates and disparities of fatal and nonfatal firearm assaults among children in New York, Los Angeles, Chicago, and Philadelphia before and during the COVID-19 pandemic.

Racial/ethnic disparities in preventive dental services use and dental caries among children.

To assess disparities in preventive dental service use in four major racial/ethnic groups and assess whether racial/ethnic and income-related disparities among children were reduced from 2016 to 2020. Data were from the 2016 and 2020 National Survey of Children's Health (NSCH). The outcomes of interest were having dental sealants, fluoride treatment, and dental caries in the past 12 months. Racial/ethnic groups included non-Hispanic (NH) whites, blacks, Hispanics, Asians, and others. Family income level was categorized as below or above the 200% federal poverty level (low-income vs. high-income). Children ages 2-17 were included (N=161,539). All data were self-reported by parents/guardians. We estimated the trends of racial/ethnic disparities in having fluoride treatment, dental sealants, and dental caries from 2016 to 2020 and tested two 2-way interactions (i.e., year by race/ethnicity, year by income) and one 3-way interaction (year by income by race/ethnicity) to assess the change in disparities from 2016 to 2020. Overall, no significant trends in receipt of fluoride treatment, dental sealants, or having dental caries were found from 2016 to 2020 among the racial/ethnic groups, except for a decreasing trend in dental sealants for Asian American children (p=0.03). Overall, NH white children were more likely to have received preventive dental services than children from minority groups (all p < 0.05); Asian American children (AOR=1.31) were more likely to have dental caries than NH white children. Disparities in receipt of evidence-based preventive services by children persisted. Continuous efforts are needed to promote the use of preventive dental services among children of minority populations.

Using the Past to Understand the Future of U.S. and Global Smoking Disparities: A Birth Cohort Perspective

Using the Past to Understand the Future of U.S. and Global Smoking Disparities: A Birth Cohort Perspective

Abstract WMP41: Changes In Stroke Mortality Among Black And White Persons Before And During Covid-19 Pandemic, United States 2015-2021

Introduction: Although stroke death rates declined since 1950s, age-adjusted rates remained higher among non-Hispanic Black (NHB) than among non-Hispanic White (NHW) persons. No study has examined changes in disparities of stroke mortality among NHB and NHW before and during the COVID-19 pandemic. Methods: We calculated age-adjusted (US 2000 population) stroke death rates per 100,000 people among NHB and NHW ages ≥35 years from 2015-2021 using CDC WONDER. We compared NHB and NHW stroke death rates from 2015-2019 (before pandemic) to 2020-2021 (during pandemic) with respect to changes in rates, rate ratios (RR) and difference-in-difference in rates. Results: Trends and disparities of overall stroke death rates before the pandemic remained consistent between NHB (100.9 to 101.6 per 100,000 people) and NHW (69.1 to 70.6 per 100,000 people), with an average difference in rates of 31.3/100,000 and RR of 1.45. During the pandemic, stroke death rates increased but with different magnitudes among NHB (110.0 and 113.4 per 100,000) and NHW (72.0 and 73.1 per 100,000). Between pre-pandemic and pandemic periods, the absolute difference in rates increased 25% from 31.3 (95% confidence interval 30.8-31.7) to 39.1 (38.3-39.8) per 100,000 and the relative difference measured by RR increased from 1.45 (1.44-1.46) to 1.54 (1.53-1.55) (p&lt;0.001). The difference-in-difference in rates and RR comparing before to during pandemic were 7.8 per 100,000 and 1.06, respectively, indicating widened disparities in stroke death rates (p&lt;0.001) (Figure). During the pandemic (2020-2021), estimated excess stroke deaths was 4,030 among NHB (9.9% more than expected deaths) and 11,790 among NHW (5.3% more than expected deaths). Conclusion: Disparities in stroke death rates between NHB and NHW widened during the COVID-19 pandemic in the United States. Identifying factors associated with the widened disparities and providing the targeted interventions may be necessary to reduce the disparities.

Disparities in Wait Times for Care Among US Veterans by Race and Ethnicity

Prior studies indicate that Black and Hispanic vs White veterans wait longer for care. However, these studies do not capture the COVID-19 pandemic, which caused care access disruptions, nor implementation of the US Department of Veterans Affairs (VA) Maintaining Internal Systems and Strengthening Integrated Outside Networks Act (MISSION), which is intended to improve care access by increasing veterans' options to use community clinicians. To determine whether wait times increased differentially for Black and Hispanic compared with White veterans from the pre-COVID-19 to COVID-19 periods given concurrent MISSION implementation. This cross-sectional study used data from the VA's Corporate Data Warehouse for fiscal years 2019 to 2021 (October 1, 2018, to September 30, 2021). Participants included Black, Hispanic, and White veterans with a new consultation for outpatient cardiology and/or orthopedic services during the study period. Multivariable mixed-effects models were used to estimate individual-level adjusted wait times and a likelihood ratio test of the significance of wait time disparity change over time. Overall mean wait times and facility-level adjusted relative mean wait time ratios. The study included 1 162 148 veterans (mean [SD] age, 63.4 [14.4] years; 80.8% men). Significant wait time disparities were evident for orthopedic services (eg, Black veterans had wait times 2.09 [95% CI, 1.57-2.61] days longer than those for White veterans) in the pre-COVID-19 period, but not for cardiology services. Mean wait times increased from the pre-COVID-19 to COVID-19 periods for both services for all 3 racial and ethnic groups (eg, Hispanic wait times for cardiology services increased 5.09 [95% CI, 3.62-6.55] days). Wait time disparities for Black veterans (4.10 [95% CI, 2.44-5.19] days) and Hispanic veterans (4.40 [95% CI, 2.76-6.05] days) vs White veterans (3.75 [95% CI, 2.30-5.19] days) increased significantly from the pre-COVID-19 to COVID-19 periods (P < .001). During the COVID-19 period, significant disparities were evident for orthopedic services (eg, mean wait times for Hispanic vs White veterans were 1.98 [95% CI, 1.32-2.64] days longer) but not for cardiology services. Although there was variation in wait time ratios across the 140 facilities, only 6 facility wait time ratios were significant during the pre-COVID-19 period and 26 during the COVID-19 period. These findings suggest that wait time disparities increased from the pre-COVID-19 to COVID-19 periods, especially for orthopedic services for both Black and Hispanic veterans, despite MISSION's goal to improve access. Facility-level analyses identified potential sites that could be targeted to reduce disparities.

New York State’s Paid Family Leave Program is Associated with More Equitable and Increased Use of Paid Leave Following Childbirth

ObjectivesThis study aimed to assess changes in paid maternity leave before and after New York’s (NY) Paid Family Leave (PFL) law went into effect (1/1/2018) and changes in disparities by maternal characteristics.MethodsWe used specific data collected on maternity leaves by women who gave birth in 2016–2018 in NY State (outside NY City) participating in the Pregnancy Risk Assessment Monitoring System survey. Multiple logistic regressions were conducted to evaluate the effect of the PFL law on prevalence of paid leave taken by women after childbirth.ResultsAfter NY’s PFL law went into effect, there was a 26% relative increase in women taking paid leave after childbirth. Use of paid leave after childbirth increased among all racial and ethnic groups. The increases were greater among Black non-Hispanic or other race non-Hispanic women, compared to white non-Hispanic women, suggesting that NY’s law was associated with more equitable use of paid leave following childbirth.Conclusions for PracticeWider implementation and greater utilization of paid maternity leave policies would promote health equity and help reduce racial/ethnic disparities in maternal and child health outcomes.

Shifting Centers of Gravity: Analyzing the Changing Patterns of Population and Economy in China

This study examined: 1) the shifting patterns of population, economy, and center of gravity in each industry using the regional center of gravity model, and 2) the socioeconomic factors influencing the economy and population in China using the geographic detector model. Several major findings included the following: First, the population and economic gravity center have shifted generally to the southwest. The centroid of gravity model can capture the changes in regional disparities from a dynamic perspective and visualize the changes over time. Second, while both the primary and secondary sectors have transferred their centers of gravity to the northwest, the tertiary sector’s center of gravity has shifted to the southwest. Third, educational resources, financial distribution, and the tertiary sector have a substantial influence on economic growth, whereas the impact of financial distribution, educational resources, and the secondary sector on population density growth is relatively significant. This study contributes to offering valuable insights into the changing patterns of population, economy, and industry in China, as well.

Rural-urban disparities in the unmet need for home visiting services among oldest-old in China: Changes over time and decomposition analysis

PurposeThis study aims to assess trends in rural-urban disparities in the prevalence of unmet community-based home visiting services need and their contributing factors from 2005 to 2018 among oldest-old in China. MethodsThe Chinese Longitudinal Healthy Longevity Survey data of oldest-old collected with a targeted random-sampling approach from half of counties/cities from 23 provinces across China was used. Unmet need was measured as the differences between healthcare services expected and available. We used Cochran-Armitage tests to test linear trends in prevalence of unmet need. Average marginal differences were estimated to measure magnitude of rural-urban disparities in prevalence of unmet need. Changes in rural-urban disparities were decomposed using Blinder-Oaxaca Decomposition technique to logit models. All analysis was performed by Stata 15.0. ResultsFrom 2005–2018, decreased trends in prevalence of unmet need were observed (overall: 62.4% to 48.6%; rural: 65.9% to 47.3%; urban: 57.5% to 49.8%) (all ptrend < 0.001). In 2017/2018, urban oldest-old reported greater prevalence of unmet need (average marginal difference, 95% CI: 3.7% [0.4%-7.1%]); affluent oldest-old reported less unmet need than their peers. Oldest-old from Central and Western China reported greater prevalence of unmet need than their Eastern peers. Increases in income (percentages of explained change, overall: 21.3%; rural: 16.9%, urban: 36.9%) mainly contributed to decreased trends in prevalence of unmet need. ConclusionsOldest-old with socioeconomic disadvantages or living in Central and Western China reported greater prevalence of unmet need. Policy efforts are warranted to ensure equitable access to home visiting services among those oldest-old.

Population mental health matters child health disparity: a national level analysis

BackgroundThe association between social distress and child health is important and attracts research interest. This study aims to examine the trend of inequality in the mortality rate for children under five (U5MR) over time and decompose the population mental health (PMH)-gradient in U5MR into different drivers at the national level.MethodsData from 1990 to 2019 on the U5MR, PMH, and potential risk factors, such as socioeconomic status, environmental exposures at the national level, health behavior, basic water and sanitation services, urbanization, healthcare level, and HIV prevalence, were collected from online databases. We described the trend of U5MR and broke down U5MR based on the countries’ risk factor status and PMH. We constructed regression models and decomposed the drivers of change in U5MR disparity based on PMH-gradient.ResultsThe difference in U5MR between countries with different levels of air pollution and income status was narrowed since 1990 for the high PMH groups. Countries with a higher level of PMH had less significant differences in U5MR between low- and middle-income groups than those with a lower level of PMH. The development of PMH-related gradient in child health is not consistent thoroughly. Before 2000, boys experienced a sharper decline in PMH-related gradient in health than girls did. The decomposition shows that the changes in PMH-gradient in child health were mainly caused by changes in the return to risk factors. The mental health of female population matters more in child health outcomes.ConclusionAlthough the U5MR converges across countries, the reason varies. The PMH gradient in child mortality is mainly explained by the change in the return to risk factors. The PMH-gradient health disparity in boys is larger than that in girls in 2019, which indicates that boys’ health may be more vulnerable to the development of PMH recently. The findings remind us that we need to pay attention to the hidden reasons for the growth of disparity. It also suggests that improving PMH has a great impact on reducing PMH-related health disparity, especially for boys. Our research contributes to the understanding of the transition of PMH-related health disparity in U5MR and provides policy implications for reducing gender disparity in child health.

An obesogenic diet uncovers disparate changes in uncoupling protein 1 content and lipid synthesis and storage in rat brown adipose tissue.

An obesogenic diet uncovers disparate changes in uncoupling protein 1 content and lipid synthesis and storage in rat brown adipose tissue.

Different Extracellular β-Amyloid (1-42) Aggregates Differentially Impair Neural Cell Adhesion and Neurite Outgrowth through Differential Induction of Scaffold Palladin.

Extracellular amyloid β-protein (1-42) (Aβ42) aggregates have been recognized as toxic agents for neural cells in vivo and in vitro. The aim of this study was to investigate the cytotoxic effects of extracellular Aβ42 aggregates in soluble (or suspended, SAβ42) and deposited (or attached, DAβ42) forms on cell adhesion/re-adhesion, neurite outgrowth, and intracellular scaffold palladin using the neural cell lines SH-SY5Y and HT22, and to elucidate the potential relevance of these effects. The effect of extracellular Aβ42 on neural cell adhesion was directly associated with their neurotrophic or neurotoxic activity, with SAβ42 aggregates reducing cell adhesion and associated live cell de-adherence more than DAβ42 aggregates, while causing higher mortality. The reduction in cell adhesion due to extracellular Aβ42 aggregates was accompanied by the impairment of neurite outgrowth, both in length and number, and similarly, SAβ42 aggregates impaired the extension of neurites more severely than DAβ42 aggregates. Further, the disparate changes of intracellular palladin induced by SAβ42 and DAβ42 aggregates, respectively, might underlie their aforementioned effects on target cells. Further, the use of anti-oligomeric Aβ42 scFv antibodies revealed that extracellular Aβ42 aggregates, especially large DAβ42 aggregates, had some independent detrimental effects, including physical barrier effects on neural cell adhesion and neuritogenesis in addition to their neurotoxicity, which might be caused by the rigid C-terminal clusters formed between adjacent Aβ42 chains in Aβ42 aggregates. Our findings, concerning how scaffold palladin responds to extracellular Aβ42 aggregates, and is closely connected with declines in cell adhesion and neurite outgrowth, provide new insights into the cytotoxicity of extracellular Aβ42 aggregates in Alzheimer disease.

Plasma metabolic disturbances during pregnancy and postpartum in women with depression.

Examining plasma metabolic profiling during pregnancy and postpartum could help clinicians understand the risk factors for postpartum depression (PPD) development. This analysis targeted paired plasma metabolites in mid-late gestational and 1month postpartum periods in women with (n= 209) or without (n= 222) PPD. Gas chromatogram-mass spectrometry was used to analyze plasma metabolites at these two time points. Among the 170 objected plasma metabolites, principal component analysis distinguished pregnancy and postpartum metabolites but failed to discriminate women with and without PPD. Compared to women without PPD, those with PPD exhibited 37 metabolites with disparate changes during pregnancy and the 1-month postpartum period and an enriched citrate cycle. Machine learning and multivariate statistical analysis identified two or three compounds that could be potential biomarkers for PPD prediction during pregnancy. Our findings suggest metabolic disturbances in women with depression and may help to elucidate metabolic processes associated with PPD development.

Changes in racial and ethnic disparities in glucose-lowering drug utilization and glycated haemoglobin A1c in US adults with diabetes: 2005-2018.

To examine changes in racial and ethnic disparities in glucose-lowering drugs (GLD) use and glycated haemoglobin A1c in US adults with diabetes from 2005 to 2018. We conducted pooled cross-sectional analysis using data from the 2005-2018 Medical Expenditure Panel Surveys, and the 2005-2018 National Health and Nutrition Examination Survey. Individuals ≥18 years with diabetes were included. Racial and ethnic disparities were measured in (a) newer non-insulin GLD use; (b) insulin analogue use; (c) non-insulin GLDs adherence; (d) insulin adherence; and (e) glucose management, along with (f) the proportion of the disparities explained by potential contributing factors. From 2005 to 2018, racial and ethnic disparities persisted in newer GLD use, non-insulin GLDs adherence, insulin analogue use and glucose management. In 2018, compared with non-Hispanic white adults, non-Hispanic black, Hispanic and other race/ethnicity groups had lower rates of using newer GLDs (adjusted risk ratio: 0.44, 0.52, 0.64, respectively; p < .05 for all) and insulin analogues (adjusted risk ratio: 0.93, 0.89, 0.95, respectively; p < .05 for all except other groups), lower non-insulin GLD adherence (proportion of days covered: -4.5%, -5.6%, -4.3%, respectively; p < .05 for all), higher glycated haemoglobin A1c (0.29%, 0.32%, 0.02%, respectively; p < .05 for all except other group), and similar insulin adherences. Socioeconomic and health status were the main contributors to these disparities. Our findings provide evidence of racial and ethnic disparities in newer GLD use and quality of care in glucose management. Our study results can inform decision-makers of the status of racial and ethnic disparities and identify ways to reduce these disparities.

Facilitating Solid Waste Handling System in Port Harcourt Cosmopolis

Port Harcourt cosmopolis grappled with a continual rise in municipal solid waste (MSW) generation. The increase is a consequence of an advance in population rise and consumption pattern. The paper reports an approximate valuation and depiction of municipal solid waste with emphasis from questionnaire survey on socio-economic status of the inhabitants in the zones that make up the cosmopolis. The methodology and procedure for this investigation obtained using vehicle selection approach centered on ASTM D5321 standard test method for ascertaining the constituents of municipal solid waste. Specimens were sorted into fourteen waste classifications of paper; 6.22%, pasteboard; 2%, plastic film; 9.05%, dense plastic; 2.73%, glass; 2.3%, iron-based metal; 3.03%, non-iron based metal; 1.13%, putrescibles; 56.3%, textiles; 1.85%, misc-ignitable; 2.83%, non-misc ignitable; 3.35%, E-waste; 2.33%, household waste; 4.88% and fine elements; 2.03%. The outcome shows an average 56.3% of municipal solid waste specimens discovered to be biodegradable. This is suitable for composting activities. Aside biodegradables, there exist, paper glass, dense plastics, and iron-based metals, which are recyclables. This is significant for providing gainful employments to the inhabitants of the cosmopolis. On the contrary, there were about 2.83% of misc-ignitable. This is suitable for energy recovery. There was a variation in specimens of MSW in all the zones that make up the cosmopolis, attributing it to changes in disparity in incomes. It is necessary for government to legalize, recycling and composting activities, which based on the waste management hierarchy process in a manner that ensures environmental sustainability, economic sustainability, and global acceptance.

Diagnóstico y tratamiento de la obesidad en adultos mexicanos: cambios entre 2006 y 2018

Introduction: Worldwide, there has been an increase in body weight. Because of this, programs have been implemented to diagnose and treat obesity. It is required to document whether these programs have led people with obesity to receive effective diagnosis and treatment. Objective: To determine and compare the changes between 2006 and 2018 in the prevalences of diagnosis and treatment of obesity and intentional weight loss among Mexican adults and to identify whether there were changes in the social disparities in these events during this period. Materials and methods: The databases of the National Health and Nutrition Survey of Mexico carried out in 2006 (N=26,738) and 2018 (N= 12,205) were analyzed. The events were diagnosis and treatment of obesity and intentional weight loss in Mexican adults with BMI &gt; 30. The independent variables were sex, age, body mass index, socioeconomic status, and geographic region. Results: From 2006 to 2018, the prevalence of people with obesity who received the diagnosis (from 20.4% to 51.1%) or treatment (from 8.3% to 21.4%) increased. The prevalence of intentional weight loss also increased (from 5.5% to 10.0%), but this was mainly in people with high socioeconomic status, Multivariate regression models revealed that, women, people with a higher BMI, and those with a higher socioeconomic status were more likely to receive diagnosis and treatment. Conclusions: Although in Mexico access to diagnosis and treatment of obesity has increased, the prevalence of intentional weight loss is low,In addition, socioeconomic disparities persist in these events.

Reducing ethnic and racial disparities by improving undertreatment, control, and engagement in blood pressure management with health information technology (REDUCE-BP) hybrid effectiveness-implementation pragmatic trial: Rationale and design

While racial/ethnic disparities in blood pressure control are documented, few interventions have successfully reduced these gaps. Under-prescribing, lack of treatment intensification, and suboptimal follow-up care are thought to be central contributors. Electronic health record (EHR) tools may help address these barriers and may be enhanced with behavioral science techniques. To evaluate the impact of a multicomponent behaviorally-informed EHR-based intervention on blood pressure control. Reducing Ethnic and racial Disparities by improving Undertreatment, Control, and Engagement in Blood Pressure management with health information technology (REDUCE-BP) (NCT05030467) is a two-arm cluster-randomized hybrid type 1 pragmatic trial in a large multi-ethnic health care system. Twenty-four clinics (>350 primary care providers [PCPs] and >10,000 eligible patients) are assigned to either multi-component EHR-based intervention or usual care. Intervention clinic PCPs will receive several EHR tools designed to reduce disparities delivered at different points, including a: (1) dashboard of all patients visible upon logging on to the EHR displaying blood pressure control by race/ethnicity compared to their PCP peers and (2) set of tools in an individual patient's chart containing decision support to encourage treatment intensification, ordering home blood pressure measurement, interventions to address health-related social needs, default text for note documentation, and enhanced patient education materials. The primary outcome is patient-level change in systolic blood pressure over 12 months between arms; secondary outcomes include changes in disparities and other clinical outcomes. REDUCE-BP will provide important insights into whether an EHR-based intervention designed using behavioral science can improve hypertension control and reduce disparities.

Changes in Racial and Ethnic Disparities of HIV Diagnoses Among Adolescents and Young Adults Aged 13–24 Years, 2015–2019

PurposeWe examined changes in racial/ethnic disparities in HIV diagnoses among adolescents and young adults aged 13–24 years from 2015 through 2019. MethodsWe used national surveillance data for 2015–2019 from AtlasPlus to calculate 12 absolute and relative disparity measures for 7 racial/ethnic groups to understand HIV diagnosis trends over time. We calculated four absolute measures (Black-to-White rate difference, Hispanic-to-White rate difference, Absolute Index of Disparity [ID], population-weighted Absolute ID) and eight relative measures (Black-to-White rate ratio, Hispanic-to-White rate ratio, ID, population-weighted ID, population attributable proportion, Gini coefficient, Theil index, and mean log deviation). ResultsHIV diagnosis rates decreased by 15.9% across all racial/ethnic groups combined. All the absolute disparity measures we examined indicated substantial reductions (13.5%–18.5%) in absolute disparities. Most of the relative disparity measures (eight of eight population-unadjusted measures and five of eight population-adjusted measures) declined as well, but the change was relatively modest and ranged from a 3.3% decrease to a 2.1% increase across the measures. DiscussionDespite progress, racial/ethnic disparities in HIV diagnoses among adolescents and young adults remain. Programs and services that are culturally relevant and tailored for this population may assist with continued progress toward reducing racial/ethnic disparities.

Changes in socioeconomic and demographic disparities for traffic-related air pollution exposure during pregnancy over a 20-year period in Texas

Background and Aim: Environmental justice issues surround population exposure to ambient air pollution; however, few studies have specifically examined traffic air pollution (a pollutant with localized concentration patterns) and pregnancy exposures (maternal-infant dyads may be particularly susceptible to air pollution effects). How socioeconomic and demographic disparities may change over time is also unclear but could have important policy implications. Methods: We identified ~ 6.9 million pregnant mothers in Texas from 1996 to 2016 using individual-level vital statistics records. We estimated traffic air pollution exposures using full residential addresses and calculated the total vehicle miles travelled (VMT) within 300 m, assigned nitrogen dioxide (NO2) concentrations from a spatial-temporal land use regression model (an indicator of vehicle tailpipe emissions), and linked the National Air Toxic Agency cancer risk index from vehicles emissions to maternal addresses. From census tract data, we examined median household income. We quantified annual absolute and relative mean percent differences in traffic air pollution across socio-demographic indicators of maternal race and ethnicity, educational attainment, and maternal birthplace. Results: We observed marked differences in traffic air pollution exposures by all socio-demographic variables examined. Overall, the strongest disparities were seen among non-White and foreign-born pregnancies. While the absolute level of disparity shrank from 1996 to 2016 (e.g., in 1996 Black individuals were exposed to NO2 levels 1.8 ppb higher than white individuals, while in 2016 NO2 levels were 1.5 ppb higher among Black compared to white individuals), the relative level of disparity continued to increase. Within census tracts (i.e., neighborhoods), we also observed sizeable disparities among socioeconomic and demographic groups. Conclusion: Despite considerable reductions in traffic-related air pollution, the magnitude of disparity has increased when we compared groups with lower socioeconomic positioning to their higher socioeconomic positioned counterparts. Keywords: traffic-related air pollution, pregnancy, environmental justice

Two cosmopolitanism events driven by different extreme paleoclimate regimes

Cosmopolitanism represents the formation of globally homogenous biotas, usually of low-diversity, and normally form under unusual environmental conditions. But the factors driving such important biogeographic states remain unclear. The Carboniferous to Triassic encompasses the Late Paleozoic Ice Age (LPIA) and a hothouse beginning in the latest Permian and persisting through the Early Triassic. These dramatic environmental changes caused complex paleobiogeographic changes and were also associated with such severe biological events as the mid-Carboniferous biotic crisis, and the end-Permian and end-Triassic mass extinctions. This interval is a unique natural window for studying biogeographic patterns under different climate backgrounds and with greatly changed taxonomic composition. In this study, we apply multiple biogeographic indices to examine two episodes of cosmopolitanism based on global marine invertebrate fossil records during the Carboniferous to Triassic. The LPIA cosmopolitanism event was characterized by high faunal similarity at middle latitudes generated by diversity loss and complex glacial/interglacial climatic changes. By contrast, the EPME cosmopolitanism event was characterized by high faunal similarity globally resulting from a faunal changeover, when communities characterized by high richness were replaced by widespread and monotonous communities with high evenness and extremely low richness. The two cosmopolitanism events differed in durations, taxon preference and geographic influence, but in both cases their driving mechanisms were linked to extreme icehouse and hothouse climates. These two episodes illustrate the complexity of deep time marine ecosystem response to climatic changes and the multiple drivers of cosmopolitanism in the marine biosphere. • Two cosmopolitanism events are found in icehouse and greenhouse climate respectively. • Multiple methods are integrated to indicate biogeographic disparity changes. • Different mechanisms are behind cosmopolitanisms when climatic backgrounds differ. • Both biotic and abiotic factors functioned in causing these cosmopolitanism events. • Cosmopolitanism events had taxa group preference under different climates.