City Census Tracts Research Articles

Community credit scores and community socioeconomic deprivation in association with type 2 diabetes across an urban to rural spectrum in Pennsylvania: a case–control study

BackgroundArea-level credit scores (the mean of credit scores for persons in a community) may be a unique indicator of community-level socioeconomic conditions associated with health outcomes. We analysed community credit...

Geographic disparities in new onset of internalizing disorders in Pennsylvania adolescents using electronic health records

We evaluated associations of community types and features with new-onset internalizing disorders among Pennsylvania adolescents to identify the location and scale of risk. Using a nested case-control study, we drew subjects from electronic health records 2008–2016, requiring cases (n = 7974) to have two medication orders or diagnoses indicating an internalizing disorder; controls (n = 31,895) were frequency-matched. Subjects were assigned to three community classifications: townships, boroughs, city census tracts; urbanized areas, urban clusters, rural areas; and a combination. Using logistic regression with generalized estimating equations, we found that compared to rural-townships, the highest odds were in urban cluster-city census tracts (odds ratio, 95% confidence interval: 1.78, 1.41–2.26); lowest in urbanized area-city census tracts (0.85, 0.74–0.97). Higher community socioeconomic deprivation was associated with increased odds in urban clusters (1.21, 1.00–1.48) and higher greenness with decreased odds in urban clusters (0.73, 0.62–0.86).

Proximity to freshwater blue space and type 2 diabetes onset: The importance of historical and economic context

Salutogenic effects of living near aquatic areas (blue space) remain underexplored, particularly in non-coastal and non-urban areas. We evaluated associations of residential proximity to inland freshwater blue space with new onset type 2 diabetes (T2D) in central and northeast Pennsylvania, USA, using medical records to conduct a nested case-control study. T2D cases (n = 15,888) were identified from diabetes diagnoses, medication orders, and laboratory test results and frequency-matched on age, sex, and encounter year to diabetes-free controls (n = 79,435). We calculated distance from individual residences to the nearest lake, river, tributary, or large stream, and residence within the 100-year floodplain. Logistic regression models adjusted for community socioeconomic deprivation and other confounding variables and stratified by community type (townships [rural/suburban], boroughs [small towns], city census tracts). Compared to individuals living ≥ 1.25 miles from blue space, those within 0.25 miles had 8% and 17% higher odds of T2D onset in townships and boroughs, respectively. Among city residents, T2D odds were 38–39% higher for those living 0.25 to < 0.75 miles from blue space. Residing within the floodplain was associated with 16% and 14% higher T2D odds in townships and boroughs. A post-hoc analysis demonstrated patterns of lower residential property values with nearer distance to the region’s predominant waterbody, suggesting unmeasured confounding by socioeconomic disadvantage. This may explain our unexpected findings of higher T2D odds with closer proximity to blue space. Our findings highlight the importance of historic and economic context and interrelated factors such as flood risk and lack of waterfront development in blue space research.

Association of community types and features in a case–control analysis of new onset type 2 diabetes across a diverse geography in Pennsylvania

ObjectivesTo evaluate associations of community types and features with new onset type 2 diabetes in diverse communities. Understanding the location and scale of geographic disparities can lead to community-level interventions.DesignNested...

Proximity to freshwater blue space and type 2 diabetes onset: the importance of historical and economic context

Background: Living near aquatic areas (blue space) may benefit health by reducing stress and providing physical activity spaces. Salutogenic effects of blue space remain underexplored, particularly in non-coastal and non-urban areas. Methods: We evaluated associations of residential proximity to inland freshwater blue space with new onset type 2 diabetes (T2D) in geographically diverse communities across 37 counties in Pennsylvania, USA, using medical records (2008-2016) to conduct a nested case-control study. T2D cases (n=15,888) were identified from diabetes diagnoses, medication orders, and laboratory test results and frequency-matched on age, sex, and encounter year to diabetes-free controls (n=79,435). Using national hydrography data, we calculated distance (0-0.24, 0.25-0.49, 0.50-0.74, 0.75-1.24, &gt;1.25 miles) from each individual’s residence to the nearest lake, river, tributary, or large stream. Logistic regression models adjusted for community socioeconomic deprivation and other confounding variables. Models were stratified by community type (townships [rural/suburban], boroughs [small towns], city census tracts). Results: Compared with individuals living farthest from blue space, those &lt;0.25 and 0.25-0.49 miles away had higher odds (odds ratio [95% confidence interval]) of T2D in townships (1.13 [1.06, 1.21]; 1.11 [1.03, 1.18]) and boroughs (1.30 [1.17, 1.44]; 1.27 [1.13, 1.41]); in cities, individuals between 0.25-0.74 miles away had higher T2D odds. Residing within the 100-year flood zone and nearest blue space type (river/tributary versus lake) were also associated with higher T2D odds. We observed lower property values for residences nearest the Susquehanna River, the region’s predominant waterbody, but were unable to adjust for property values due to limited data availability. Conclusions: Unmeasured confounding by socioeconomic disadvantage may explain our unexpected findings of higher T2D odds with closer proximity to freshwater blue space. Proximity to blue space may be detrimental to health depending on historic and economic context and interrelated factors such as flood risk, pollution, and lack of waterfront development.

Does demand lead supply? Gentrifiers and developers in the sequence of gentrification, New York City 2009–2016

Consumption-side theorists of gentrification examine the flow of middle-class White people into previously working-class neighbourhoods and argue that their demand for housing stimulates gentrification. In contrast, production-side theorists emphasise the movement of capital into previously disinvested neighbourhoods and contend that profit-seeking development increases property values and sparks gentrification. Hybrid theorists argue that consumption and production occur simultaneously. This article operationalises arguments made by each approach, and asks: Do gentrifiers precede rising home values or do rising home values precede gentrifiers? To answer this question of sequence, we build a dataset of census and property tax assessment data for 2192 New York City census tracts between 2009 and 2016. Using cross-lagged regression models with tract and year fixed effects, we find neighbourhoods that experienced an increase in White, middle-class residents had related housing price spikes in each of the subsequent two years. A 1% increase in gentrifiers was associated with a subsequent 2.7% increase in property values. However, housing market growth did not predict future increases in gentrifiers. This suggests that consumption leads production during neighbourhood gentrification, and that developers are reactive, not proactive, in their investment decisions. Focusing on the sequence of gentrification’s subsidiary elements enables city officials, non-profits and social movements to better anticipate gentrification and develop more targeted policies.

Associations of multidimensional socioeconomic and built environment factors with body mass index trajectories among youth in geographically heterogeneous communities.

Understanding contextual influences on obesity requires comparison of heterogeneous communities and concurrent assessment of multiple contextual domains. We used a theoretically-based measurement model to assess multidimensional socioeconomic and built environment factors theorized to influence childhood obesity across a diverse geography ranging from rural to urban. Confirmatory factor analysis specified four factors—community socioeconomic deprivation (CSED), food outlet abundance (FOOD), fitness and recreational assets (FIT), and utilitarian physical activity favorability (UTIL)—which were assigned to communities (townships, boroughs, city census tracts) in 37 Pennsylvania counties. Using electronic health records from 2001 to 2012 from 163,820 youth aged 3–18 years from 1288 communities, we conducted multilevel linear regression analyses with factor quartiles and their cross products with age, age2, and age3 to test whether community factors impacted body mass index (BMI) growth trajectories. Models controlled for sex, age, race/ethnicity, and Medical Assistance. Factor scores were lowest in townships, indicating less deprivation, fewer food and physical activity outlets, and lower utilitarian physical activity favorability. BMI at average age was lower in townships versus boroughs (beta [SE]) (0.217 [0.027], P < 0.001) and cities (0.378 [0.036], P < 0.001), as was BMI growth over time. Factor distributions across community types lacked overlap, requiring stratified analyses to avoid extrapolation. In townships, FOOD, UTIL, and FIT were inversely associated with BMI trajectories. Across community types, youth in the lowest (versus higher) CSED quartiles had lower BMI at average age and slower BMI growth, signifying the importance of community deprivation to the obesogenicity of environments.

Incarceration and the Economic Fortunes of Urban Neighborhoods

New research has identified the consequences of high rates of incarceration on neighborhood crime rates, but few studies have looked beyond crime to examine the collateral effects of incarceration on the social and economic well being of the neighborhoods themselves and their residents. We assess two specific indicia of neighborhood economic well-being, household income and human capital, dimensions that are robust predictors of elevated crime, enforcement and incarceration rates. We decompose incarceration effects by neighborhood racial composition and socio-economic conditions to account for structural disadvantages in labor force and access to wealth that flow from persistent patterns of residential segregation. We use panel methods to examine the effects on incarceration on New York City census tracts over an 11 year period from 1985-1996, a period which saw crime rates rise and fall sharply, and when incarceration rates increased and remained high in concentrated areas throughout the city. We examine whether persistently high incarceration rates erode human capital and depress median household incomes, further intensifying incarceration risks and threatening to create conditions where incarceration and economic disadvantage become endogenous features of certain neighborhoods. We find distinct but overlapping effects for prisons and jails, suggesting that these are parallel processes produced by loosely coupled law enforcement priorities. Incarceration effects are greater for household income than human capital, suggesting a complex relationship between persistent poverty, residential segregation, and incarceration that reinforces a classic poverty trap. Household incomes are lower over time in neighborhoods with higher proportions of African American population, even after controlling for the effects of race on incarceration, but we find no similar effects for Hispanic populations. Spatially targeted policies such as microinvestment and housing development may be needed offset the local embeddedness of poverty and disrupt its connections to incarceration and crime, while education policy and transitional labor market networking can strengthen local human capital.

Elevating access: Comparing accessibility to jobs by public transport for individuals with and without a physical disability

Equal access to opportunities has emerged in public transport planning as a social objective that many transport agencies are trying to achieve. Yet in practice, not all public transport agencies are currently providing urban residents with comparable levels of service due to physical barriers in the public transport network that can significantly hinder the ability of individuals with physical disabilities to access opportunities. In countries without a strong federal accessibility act and/or with major financial constraints, some public transport agencies fall behind in applying universal access design principles, making it even harder for people with a physical disability to access opportunities. The objective of this study is to develop a methodology that can be used by public transport agencies or disability advocates to clearly highlight and quantify the performance of the public transport network in a region, in terms of providing transit services to people in a wheelchair and compare that to the service offered to an individual not in a wheelchair. In this study we use accessibility, the ease of reaching destinations, by public transport as the key performance measure in two major Canadian Cities (Montreal and Toronto). Furthermore, we focus on job accessibility in the most socially vulnerable census tracts in both cities, to evaluate levels of job accessibility for wheelchair users residing in socially vulnerable areas. The findings from our study show striking contrasts between the numbers of accessible jobs by public transport for wheelchair users compared to the general population. On average, wheelchair users in Toronto have access to 75% of jobs that are accessible to users that are not in a wheelchair, whilst their counterparts in Montreal have access to only 46% of the jobs accessible to other users. This research is expected to highlight for public transport engineers, planners, policy makers and advocates for those with disabilities, the importance of universal access in a region, especially along public transport networks, using a widely used land use and transport performance measure.

Psychological resilience after Hurricane Sandy: the influence of individual- and community-level factors on mental health after a large-scale natural disaster.

Several individual-level factors are known to promote psychological resilience in the aftermath of disasters. Far less is known about the role of community-level factors in shaping postdisaster mental health. The purpose of this study was to explore the influence of both individual- and community-level factors on resilience after Hurricane Sandy. A representative sample of household residents (N = 418) from 293 New York City census tracts that were most heavily affected by the storm completed telephone interviews approximately 13–16 months postdisaster. Multilevel multivariable models explored the independent and interactive contributions of individual- and community-level factors to posttraumatic stress and depression symptoms. At the individual-level, having experienced or witnessed any lifetime traumatic event was significantly associated with higher depression and posttraumatic stress, whereas demographic characteristics (e.g., older age, non-Hispanic Black race) and more disaster-related stressors were significantly associated with higher posttraumatic stress only. At the community-level, living in an area with higher social capital was significantly associated with higher posttraumatic stress. Additionally, higher community economic development was associated with lower risk of depression only among participants who did not experience any disaster-related stressors. These results provide evidence that individual- and community-level resources and exposure operate in tandem to shape postdisaster resilience.

Change in neighborhood environments and depressive symptoms in New York City: The Multi-Ethnic Study of Atherosclerosis

Physical and social features of neighborhoods, such as esthetic environments and social cohesion, change over time. The extent to which changes in neighborhood conditions are associated with changes in mental health outcomes has not been well-established. Using data from the MultiEthnic Study of Atherosclerosis, this study investigated the degree to which neighborhood social cohesion, stress, violence, safety and/or the esthetic environment changed between 2002 and 2007 in 103 New York City Census tracts and the associations of these changes with changes in depressive symptoms. Neighborhoods became less stressful, more socially cohesive, safer, and less violent. White, wealthy, highly educated individuals tended to live in neighborhoods with greater decreasing violence and stress and increasing social cohesion. Individuals living in neighborhoods with adverse changes were more likely to have increased CES-D scores, although due to limited sample size associations were imprecisely estimated (P>0.05). Changes in specific features of the neighborhood environment may be associated with changes in level of depressive symptoms among residents.

PS2-35: Associations of Body Mass Index with Measures of the Built and Social Environments in Children and Adolescents: The Environmental Health Institute Child and Adolescent Obesity Study

Background/AimsNo prior studies in children have evaluated how age may modify relations of the built and social environments with obesity outcomes, nor evaluated the range of scales and contexts over which these influences may operate.MethodsWe performed a cross-sectional, multilevel analysis of body mass index (BMI) data from over 47,000 Geisinger primary care patients 5 to 18 years old, residing in a 31-county region of Pennsylvania. Individual-level data were obtained from the clinic?s electronic health record. A total of 33 environmental measures were derived to characterize land use (e.g., population density, intersection density, average block size), land use change (e.g., change in population and population density 1990 to 2000), physical activity (e.g., density and diversity of and accessibility to nine categories of physical activity establishments), and social environments (e.g., indexes of community socioeconomic deprivation and social disorganization). Associations of environmental measures with BMI z-scores were evaluated in various contexts and at a range of scales (e.g., 0.5 mi network buffers, census tracts, minor civil divisions [townships, boroughs, cities], a mixed definition of place [townships, boroughs, census tracts in cities], counties), first in all children and also in three age strata (5?9, 10?13, and 14?18 years), controlling for individual-level covariates.ResultsIn all children, only lower community socioeconomic deprivation and higher diversity of physical activity establishments were associated with lower BMI. There were some differences in associations of environmental measures in the age strata, especially when comparing associations in the various scales and contexts. For example, higher population density was associated with lower BMI in older children, and this effect appeared to operate most clearly in the larger contexts. Similarly, lower county sprawl was also associated with lower BMI in older children.ConclusionsThere was some evidence of effect modification by age. This suggests that no single intervention to change the built environment is likely to be effective across the childhood age range. The observation that surrogates for compact development may operate over larger contexts can be a challenge in many regions of the U.S. as zoning and planning are generally done on smaller scales.

Body Mass Index and the Built and Social Environments in Children and Adolescents Using Electronic Health Records

No prior studies in children have evaluated how age may modify relationships of the built and social environments with BMI, nor evaluated the range of scales and contexts over which places may influence health. To systematically evaluate associations of 33 environmental measures in three domains (land use, physical activity, and social environments) with BMI in children and adolescents in five geographies. A cross-sectional, multilevel analysis was completed in 2009-2010 of electronic health record data (2001-2008) from 47,769 children aged 5-18 years residing in a 31-county region of Pennsylvania. Associations of environmental measures with BMI were evaluated using 0.5-mile network buffers; census tracts; minor civil divisions (i.e., townships, boroughs, cities); a mixed definition of place (townships, boroughs, and census tracts in cities); and counties, overall and by age strata. Among all children, lower levels of community socioeconomic deprivation and greater diversity of physical activity establishments were associated with lower BMI. Associations of environmental measures differed by age, depending on scale and context. For example, higher population density was associated with lower BMI in older children; this effect was strongest in the larger geographies. Similarly, a lower level of county sprawl was associated with lower BMI in older children. Associations differed by age and definition of place, suggesting that the benefits of environmental intervention may not be uniform across the childhood age range. The study demonstrated the utility of using electronic patient information for large-scale, population-based epidemiologic research, a research area of growing interest and investment in the U.S.

Economic deprivation and racial segregation: Comparing Superfund sites in Portland, Oregon and Detroit, Michigan

The research presented here weighs the ability of two major explanations of social inequality—Massey and Denton’s racial segregation explanation and Wilson’s emphasis on economic deprivation (concentrated poverty)—to predict environmental inequality. Two sets of logistic regression analyses are used to predict the location of Superfund sites in Portland, Oregon and Detroit, Michigan providing a conditional understanding of environmental inequality within a larger sociological context. The analysis includes a general examination of the two theories in all census tracts in both cities and a set of analyses focusing upon Black neighborhoods in Detroit. The findings indicate that there is support for explanations of environmental inequality that include both racial segregation and economic deprivation, but that the more powerful of the two is economic deprivation. The results suggest that even though African-American neighborhoods disproportionately house Superfund sites, these facilities are more likely to be located in Black neighborhoods that are economically deprived.

Neighborhood Ecology and Drug Dependence Mortality: An Analysis of New York City Census Tracts

Drug dependence mortality appears to be highly concentrated in certain disadvantaged populations and in certain disadvantaged areas. Using a relatively large sample of census tract data for New York City, 1991–1995 (N = 2,037), the present study examines the structural covariates of drug dependence mortality rates. Spatially lagged negative binomial regression analyses indicated considerable support for previous findings regarding the importance of poverty as a predictor of drug mortality. Furthermore, two variables especially relevant for the social disorganization and deviant opportunity perspectives in criminology exhibited significant independent effects: the neighborhood homeownership rate and the prevalence of boarded-up housing. The results support various policy initiatives concerned with the relationship between neighborhood environment and public health.

Depressive symptoms and associated factors in an elderly population in southern Brazil

To determine the frequency of some depressive symptoms in the elderly, to build up a score of depressive symptoms and to evaluate the association between depressive symptoms and demographic, socioeconomic and behavioral variables. A population-based cross-sectional study was conducted in individuals aged 60 and more living in the urban city area of Pelotas, Brazil. The sample was selected in multiple stages based on the city's census tracts. It was used a questionnaire comprising eight question commonly included in depression evaluation instruments and specific to the elderly. Analyses were carried out using multiple linear regressions following a hierarchical approach. A total of 583 subjects were interviewed and non-response rate was 4.7%. Each participant had on the average score of depressive symptoms was 3.4 (SD 2.1)Lack of willingness to carry out daily activities was the most frequent symptom (73.9%) reported. In the adjusted analysis according to the conceptual framework, the following groups had statistically higher averages (p<0.05) of depressive symptoms: older women, individuals with less schooling, unemployed, smokers, and those whose family member or significant other died in the past year. It was found both high rates of isolated symptoms and high average of depressive symptoms in the study sample, highlighting the importance of studying specific symptoms of the elderly, which are different from those found in young adults.

Self-reported adherence, management behavior, and barriers to care after an emergency department visit by inner city children with asthma.

The inability to adhere to a prescribed therapeutic program for the treatment of a chronic disease may be responsible in part for continued disease activity. This problem may be more of an issue in the treatment of asthma, a common, potentially lethal chronic condition in which the lack of symptoms may be interpreted as remission. Adherence was one of the key areas of interest for the National Cooperative Inner-City Asthma Study. The focus of this study was to identify those issues reported by families that could adversely affect their adherence to an asthma care program. The identification of barriers to adherence could then form the basis of a successful intervention program. This study describes barriers to adherence, asthma management behavior, and self-reported adherence. Patients presenting during an acute attack of asthma at an emergency department (ED) were recruited for this study. The medical record of the ED encounter was abstracted and compared with information that was obtained during a baseline interview 3 to 5 weeks later. During the baseline interview, parents were asked about health care behaviors related to adherence. There were 344 children 4 to 9 years of age living in inner city census tracts in the study. Four areas of adherence (medicine use, appointment-keeping, emergency actions, and asthma attack prevention) were investigated. The parental report of medications prescribed at the ED and the information on the abstracted ED report agreed 94.9% of the time for the beta-agonists, 86.8% for steroids, and 69.4% for cromolyn. Among respondents, 85.4% of parents reported that they are able to follow the ED recommendations almost all of the time; side effects of medicines were a concern for 81.1% of caretakers who were adherent and for 89.5% of caretakers who were nonadherent. Doubts regarding the usefulness of medications occurred in 34.4% of those considered adherent and 54.2% who admitted nonadherence. Medications were forgotten some of the time by 45.2% of the children, and 52.8% tried to get out of taking medicine. Appointments for follow-up care were kept by 69% of those given an appointment in the ED, by an estimated 60.0% of those who were told specifically to call for an appointment, and by an estimated 25.2% of those who were neither given an appointment nor told specifically to make one. Only one third of parents report that they were able to keep the child away from known asthma triggers nearly all of the time. Approximately half avoided allergens; however, only 37.5% reported avoidance of cigarette smoke. The use of preventive medicines occurred in 23.5%. Using a medicine and taking the child to a physician were reported as the first or second action during an acute attack of asthma by 72.1% of respondents. Adherence to an asthma-management program involves a number of areas: medication, appointment-keeping, prevention, and applying an emergency plan of action. Barriers to adherence may exist in one or all four of these areas, leading to ineffective control of asthma. Recommendations are made for improving the patient-physician partnership to improve adherence.

The Residential Mobility of Ethnic Minorities: A Longitudinal Analysis

Studies of ethnic minority settlement in major cities usually depend upon snapshot evidence derived from periodic population censuses. The objects of such research are usually city regions, neighbourhoods or census tracts, and changes through time can not be undertaken as process studies but only as comparisons between given dates. In discussing the residential mobility experiences of ethnic minority populations it would be extremely valuable to be able to use individuals as the research units instead of geographical areas. This possibility exists for the study of ethnic minority residential mobility in the Paris region through the secondary analysis of a major survey carried out in 1986 by the French National Demographic Research Institute (INED). The results of such an analysis lead to a questioning of certain established ideas on the importance of the inner city for residence, but provide confirmation of higher-than-average mobility rates.

A NONTRADITIONAL METHODOLOGY FOR FLOOD STAGE‐DAMAGE CALCULATIONS1

ABSTRACT: This paper presents a new methodology to calculate economic losses from hypothetical, extreme flood events, such as the Probable Maximum Flood. The methodology uses economic data compiled from already‐available secondary sources, such as U.S. Census data on magnetic tapes, utilizing microcomputer and other electronic media. Estimates of land elevations are obtained from topographic maps, and flood elevations axe estimated using, for example, a dam breach and flood routing (DAMBRK) model (Fread, 1984). The calculations are performed at a disaggregate spatial scale, by various land use and industrial classification categories. The basic areal units are city blocks (for urbanized areas), enumeration districts, and Census tracts. Depth‐damage functions, which provide an estimate of damages as a proportion of the existing value of the structure, are estimated statistically. Computer software (called DAMAGE) is used to combine the economic, flood elevation, and depth‐damage information to compute economic losses for different possible flood stages and for different inflow events. Two case studies are presented as illustrations of the method.

Regulating Scarcity: The Effects of Zoning on Urban Land Market Changes

This paper explores the dynamics between zoning, land values and neighborhood change from 1960 to 1970. Using a sample of 352 central city and suburban census tracts contained within the Chicago SMSA, this paper examines the influence of zoning on neighborhood land value appreciation and the independent effects of land values and zoning on neighborhood housing changes. Findings show that zoning influenced land value appreciation over the decade within both central city and suburban areas. Central city zoning and land values operated jointly to influence neighborhood housing changes while in suburban areas, zoning mechanisms overrode market forces in influencing neighborhood development patterns. This paper demonstrates the forcefulness of the politics of the urban land market in regulating both land scarcity and land value changes and in influencing metropolitan spatial distributions.