Community Socioeconomic Factors Research Articles

Discussion to: Unplanned readmissions, community socioeconomic factors, and their effects on long-term survival after complex thoracic aortic surgery

Discussion to: Unplanned readmissions, community socioeconomic factors, and their effects on long-term survival after complex thoracic aortic surgery

Unplanned readmissions, community socioeconomic factors, and their effects on long-term survival after complex thoracic aortic surgery

ObjectiveWe evaluated community socioeconomic factors in patients who had unplanned readmission after undergoing proximal aortic surgery (ascending aorta, aortic root, or arch). MethodsUnplanned readmissions for any reason within 60 days of the index procedure were reviewed by race, acuity at presentation, and gender. We also evaluated 3 community socioeconomic factors: poverty, household income, and education. Kaplan-Meier survival curves were used to assess long-term survival differences by group (race, acuity, and gender). ResultsAmong 2339 patients who underwent proximal aortic surgery during the 20-year study period and were discharged alive, our team identified 146 (6.2%) unplanned readmissions. Compared with White patients, Black patients lived in areas characterized by more widespread poverty (20.8% vs 11.1%; P = .0003), lower income ($42,776 vs $65,193; P = .0007), and fewer residents with a high school diploma (73.7% vs 90.1%; P < .0001). Compared with patients whose index operation was elective, patients who had urgent or emergency index procedures lived in areas with lower income ($54,425 vs $64,846; P = .01) and fewer residents with a high school diploma (81.1% vs 89.2%; P = .005). Community socioeconomic factors did not differ by gender. Four- and 6-year survival estimates were 63.1% and 63.1% for Black patients versus 89.1% and 83.0% for White patients (P = .0009). No significant differences by acuity or gender were found. ConclusionsAmong readmitted patients, Black patients and patients who had emergency surgery had less favorable community socioeconomic factors and poorer long-term survival. Earlier and more frequent follow-up in these patients should be considered. Developing off-campus clinics and specific postdischarge measures targeting these patients is important.

The intersection of community socioeconomic factors with gender on outcomes after thoracic aortic surgery

ObjectiveWe evaluated the relationship among community socioeconomic factors (poverty, income, and education), gender, and outcomes in patients who underwent ascending aortic, root, and arch surgery. MethodsFor 2634 consecutive patients, we associated patients' ZIP codes with community socioeconomic factors. The composite adverse outcome comprised death, persistent neurological injury, and renal failure necessitating dialysis at discharge. Multivariable analysis and Kaplan–Meier survival curves were used. Men and women from the full cohort and from the elective patients were propensity matched. ResultsMedian follow-up was 3.6 years (interquartile range, 1.2-9.3). Men lived in areas characterized by less poverty (P = .03), higher household income (P = .01), and more education (P = .02) than women; likewise, in the elective cohort, all community socioeconomic factors favored men (P ≤ .009). Female gender predicted composite adverse outcome (P = .006). In the propensity-matched women and men (820 pairs), the composite adverse outcome rates were 14.2% and 11%, respectively (P = .06). In 583 propensity-matched pairs of elective patients, men had less composite adverse outcome (P = .02), operative mortality (P = .04), and renal (P = .02) and respiratory failure (P = .0006). The 5- and 10-year survivals for these men and women were 74.2% versus 71.4% and 50.2% versus 48.2%, respectively (P = .06). All community socioeconomic factors in both propensity-matched groups nonsignificantly favored men. ConclusionsThis study is among the first to examine the association among community socioeconomic factors, gender, and outcomes in patients who undergo proximal aortic surgery. Female gender predicted a composite adverse outcome. In the elective patients, most adverse outcomes were significantly less in men. In the propensity-matched patients, all community socioeconomic factors favored men, although not significantly. Larger studies with patient-level socioeconomic information are needed.

Socio-Economic Factors Affecting Water Use in Lower Thiba Sub-Catchment, Kirinyaga County, Kenya

Human related activities affect how water is used. However, there is limited information on the effect of socio-economic factors on water use. This study was to establish the socio-economic factors that affect water resource use in Lower Thiba Sub-Catchment using a descriptive survey design. Qualitative as well as quantitative data was collected from 361 households and 5 focus group discussions (n=366) across the Sub-catchment. The sub-catchment was sub-divided into three zones namely; upper zone, middle zone and lower zone, from where each zone, 120 respondents were randomly sampled and issued with a questionnaire. Data was analysed with the help of Statistical Package for Social Sciences (SPSS) at a statistical significance of 5% probability level. Data was then presented using descriptive statistics such as tables, graphs and test for significance was done using Chi-square. The results showed that men were more likely to do irrigation farming than women, with 81%, as compared to their female counterparts who had 68%. Most of the respondents (82%) earned between Kshs. 10,000 (87$) and 30,000 (261$) from different occupations; however, 4% of respondents, all of who were farmers earned over kshs 70,000(609$) a month, compared to other types of occupation, indicating it as the main economic activity in the area. The results showed that 57.9% of respondents who had tertiary education preferred formal employment over farming with only 9.9% of them choosing to be farmers. The results also showed 75% of the respondents who owned land were male, with only 25% of the female respondents owning land. Further, respondents in formal employment had a higher ownership (83.9%) of water harvesting facilities compared to those doing irrigation farming at 73%. The results indicate that the community socioeconomic factors within the LTS should be considered by policy makers, as they clearly affect water use within the sub-catchment.

Social capital and health outcomes among older adults in India: a multilevel analysis

PurposeThe social capital theory is increasingly being looked at as a valuable paradigm to understand if community socioeconomic factors influence health behaviours and outcomes. This requires an understanding of the forms in which social capital manifests and the levels at which it operates.Design/methodology/approachThus, the purpose of this paper is to study if social capital is associated with health outcomes among older adults in India and providing an estimate of the extent to which the neighbourhood differences in health outcomes among the older adults can be attributed to social capital.FindingsThe authors find several forms of social capital to be associated with health outcomes among older adults. The results show that community-level social capital variables collectively explain 12.81% unexplained neighbourhood variation in self-rated health, 2.5% variation in psychological well-being and 11.32% variation in the ability to perform activities of daily living, respectively.Originality/valueThe findings highlight the role social capital plays in serving as a coping mechanism for older adults to survive deteriorating health and social exclusion and call for conscious investment in building social capital.

Forest Bio-Hubs to Enhance Forest Health While Supporting the Emerging Bioeconomy—A Comparison between Three U.S. Regions

The emerging bioeconomy requires new supply chain paradigms for biomass materials to reach processing centers. Forest bio-hubs can be thought of as networks of collection points to facilitate biomass supply chains that feed from forest to central processing facilities. The design and functionality of forest bio-hubs depends on the form (e.g., vertically and horizontally integrated), and the quality and volume of feedstocks. In this paper we conceptually develop the potential role of forest bio-hubs. We then compare current bio-hub development in three U.S. regions—the Pacific Northwest, the southwest region, and the southeastern U.S. We use a “SWOT” framework to compare strengths, weaknesses, opportunities, and threats for each region. We consider transportation distances, topography, proximity to markets, harvesting methods, and wood products development. Innovation and adaptability would play key roles in forest bio-hub development, especially with dynamic conditions related to markets, wildfire risks, biomass utilization policy, and community socioeconomic factors.

Racial differences in primary sclerosing cholangitis mortality is associated with community socioeconomic status.

Natural history and outcomes data in PSC are mostly derived from cohorts where Blacks have been underrepresented. It is unknown if there are differences in mortality between Blacks and Whites with PSC. PSC patients seen at our institution from June 1988 to Jan 2019 were identified by merging prospective ERCP hepatology-clinic databases and liver-transplant registry. Data on race, clinical events, and death was obtained through chart review. Data on community health were collected using indices from county health rankings. Cumulative incidence of death was calculated using liver transplant (LT) as a competing risk. Of 449 patients, 404 were White and 45 were Black. The median-duration of follow-up was 7years (IQR:3, 13). Black patients were younger at presentation than White patients (36.3 vs 42.5years., P=.013). Disease severity as indicated by Mayo Risk Score categories (low 27% vs 31%, intermediate 54% vs 49% and high 19% vs 19%, P=.690), comorbidity burden and frequency of cirrhosis (42% vs 35%, P=.411) were similar between Blacks and Whites. Cumulative incidence of liver-related death, with LT as a competing risk was significantly higher in Blacks compared to Whites (sHR 1.80, 95%CI 1.25, 2.61, P=.002). There was a significant interaction between race and community socioeconomic factors that attenuated the racial difference in mortality (sHR 1.01, 95%CI 0.99, 1.04, P=.345). Blacks with PSC present at a younger age with a similar disease severity as Whites but have higher liver related mortality that is mediated in part through community health.

Individual and community socioeconomic factors related to the quality of antenatal care: a multilevel analysis of West and Central Africa

ABSTRACT Antenatal care (ANC) can improve maternal health. We examined associations of individual and community socioeconomic status (SES) with the quality of ANC in West and Central Africa. Data were from the 2009–2011 UNICEF Multiple Indicator Cluster Surveys for women in seven countries (n = 24,718). Individual SES variables included women’s education and wealth; community SES was defined as low or high poverty index. ANC quality was defined as receiving six services: blood pressure monitoring, blood tests, urine tests, malaria prophylaxis, tetanus vaccine, and HIV screening, and coded low or high. We used multilevel logistic regression to estimate fixed and random effects of individual and community SES on ANC quality. Less than one-fourth of women received high-quality ANC. Only small percentages of women had malaria prophylaxis and were counseled and tested for HIV. In adjusted country-stratified results, living in a poor community was associated with reduced odds of receiving high-quality ANC in six countries (Central African Republic: odds ratio, OR = 0.76; 95% confidence interval, CI:0.58–0.98; Chad: OR = 0.48; CI:0.32–0.74; Ghana: OR = 0.86; CI:0.61–0.97; Nigeria: OR = 0.74; CI:0.61–0.92; Sierra Leone: OR = 0.71; CI:0.57–0.91; and Togo: OR = 0.80; CI:0.47–0.91). The health system may be missing important opportunities to provide high-quality ANC and, thereby, improve pregnancy outcomes in these settings.

How Are Community Socio-Economic Factors Associated with the Sales of Unhealthy Products: Alcohol, Tobacco and Unhealthy Snack Food in Low Income Communities

Abstract Objectives People under stress tend to use unhealthy coping mechanisms including using products like alcohol, tobacco and unhealthy snacks. The purpose of this study is to assess how measures of community socio-economic status, which may be proxies for community stress, are associated with the sales of unhealthy products (alcohol, tobacco, and unhealthy snacks) at a discount variety store chain. Specifically, we consider the following measures of community socio-economic status: population racial/ethnic composition, % of households on SNAP, % of households without a vehicle, walkability score and median community income. Methods Mixed effects linear regressions with random effects were used to examine the relationship between the weekly unit sales (per 1000 population) of three outcome variables (tobacco, alcohol, unhealthy snacks) and community socio-economic factors: % of households on SNAP, % of households without a vehicle, and median community income. Results The sales of alcohol, tobacco, and unhealthy snacks increased as the % of the population participating in SNAP increased. Other measures of community socio-economic status were not significantly (at 5% significance level) associated with tobacco or unhealthy snack sales. However, for alcohol sales, increases in: the median household income, walkability score and % of African American residents, were associated with a decrease in alcohol sales. Conclusions Low income neighborhoods frequently experience greater health burden compared to higher income neighborhoods. Understanding and quantifying the relationship between financial stress and unhealthy product consumption can help public health professionals intervene before chronic diseases manifest. Funding Sources Robert Woods Johnson Foundation.

Contribution of Non-Timber Forest Products in Rural Communities’ Livelihoods around Chilimo Forest, West Shewa, Ethiopia

In recent decades there has been growing interest in the contribution of non-timber forest products (NTFPs) for rural people livelihood improvement and poverty alleviation. However, as to the knowledge of the present researcher, limited studies have been done to analyze the role of non-timber forest products for rural livelihood diversification. Therefore, this study was conducted to identify main NTFPs used by local communities around Chilimo Forest. Furthermore, the study aimed to determine socioeconomic factors influencing collection of NTFPs in the study area. Multistage sampling techniques were used for the study. Data for the study was generated through household survey comprising of 313 respondents selected through simple random technique and substantiated by in-depth interviews of key informants, focus group discussion and field observation. Descriptive statistics and linear regression analysis were used to analyze and summarize data. The results revealed that, crop production, animal husbandry, non timber forest product and non-farm activities were the major livelihood strategies in the study area. On average, income from NTFPs accounted for 29.34% of total household income. The commonly collected NTFPs were firewood, charcoal, grasses, herbal medicine and honey. The study found that, households derived a significant portion of their income from the collection of NTFPs; however income derived from the collection of NTFPs significantly influenced with gender, family size and wealth status while age, education, marital status and distance from forest were found to have no significance association with income sourced from NTFPs. This study also revealed that, enrichment planting of the most utilized tree species, participatory forest management and setting of harvesting levels and cycles in Chilimo forest reduce impacts on plant species that are in high demand by local communities. The findings suggest that NTFPs play an important role in supporting livelihoods, and therefore provide an important safety net for households throughout the year particularly during periods of hardship. Therefore the current research would be useful in preparing an ecologically viable policy for the subsistence of forest dwellers and better management of the forest resources in Chilimo forest. Keywords: Chilimo forest, non timber forest product, rural community socio-economic factors DOI : 10.7176/JNSR/9-22-04 Publication date: November 30 th 2019

Media Sinopsis Cerita Beraspek Multikultural Untuk Meningkatkan Apresiasi Keberagaman Siswa Dalam Pembelajaran IPS di SMPN 2 Jati Kudus

&lt;table border="1" cellspacing="0" cellpadding="0"&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td valign="top" width="508"&gt;&lt;p class="Abstrakabstract"&gt;The purpose of the research is to describe the facts that causing lack of student diversity appreciation at SMPN 2 Jati Kudus. The next is to clarify that Social Science learning activities using synopsis media with multiculturalism aspect efectively to improve student diversity appreciation at SMPN 2 Jati. The research design used in this study is a qualitative research with a case study approach . Subjects researched are relatively limited , focus of research concerning variable and very broad social dimension because it involves students at once psychological dimensions that are influenced by social and civic life. Implementation of this strategy was observed in the social studies class IX with a synopsis media with multiculturalism aspect. Phenomena analyzed classes ranging from: syllabus, lesson plans, preparation of teaching materials or the use of media to arouse the interest of students to understand the concepts of multiculturalism. Students are also given a set of questionnaire contains an attitude scale that contains student opinions about the diversity of ethnicity, religion in the school and the outside. The data were obtained as follows : the causing factor of a lack of student diversity appreciation at the school because the quality of teaching and learning in these schools. The major factor is the weakness of quality and quantity of social studies teachers. in addition to the surrounding community socio-economic factors behind most impoverished immigrant population. After learning social science with Media Synopsis students begin to understand what is the meaning of the multiculturalism concepts. Students want to hangout and work in group with no barriers of differences culture. When evaluation the results are satisfactory, an average score of 78.6, which means obtaining complete and almost students familiar of multicultural concepts.&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt;

The Magnitude of a Community's Health Needs and Nonprofit Hospitals' Progress in Meeting Those Needs: Are We Faced With a Paradox?

Although most nonprofit hospitals are required to conduct periodic community health needs assessments (CHNAs), such assessments arguably are most critical for communities with substantial health needs. The objective of this study was to describe differences in progress in conducting CHNAs between hospitals located in communities with the greatest compared with the fewest health needs. We used data on CHNA activity from the 2013 tax filings of 1331 US hospitals combined with data on community health needs from the County Health Rankings. We used bivariate and multivariate analyses to examine differences in hospitals' progress in implementing comprehensive CHNAs using 4 activities: (1) strategies to address identified needs, (2) participation in developing community-wide plans, (3) including CHNA into a hospital's operational plan, and (4) developing a budget to address identified needs. We compared progress in communities with the greatest and the fewest health needs using a comprehensive indicator comprising a community's socioeconomic factors, health behaviors, access to medical care, and physical environment. In 2013, nonprofit hospitals serving communities with the greatest health needs conducted an average of 2.5 of the 4 CHNA activities, whereas hospitals serving communities with the fewest health needs conducted an average of 2.7 activities. Multivariate analysis, however, showed a negative but not significant relationship between the magnitude of a community's health needs and a hospital's progress in implementing comprehensive CHNAs. Hospitals serving communities with the greatest health needs face high demand for free and reduced-cost care, which may limit their ability to invest more of their community benefit dollars in initiatives aimed at improving the health of the community.

Association between community socioeconomic factors, animal feeding operations, and campylobacteriosis incidence rates: Foodborne Diseases Active Surveillance Network (FoodNet), 2004-2010.

BackgroundCampylobacter is a leading cause of foodborne illness in the United States. Campylobacter infections have been associated with individual risk factors, such as the consumption of poultry and raw milk. Recently, a Maryland-based study identified community socioeconomic and environmental factors that are also associated with campylobacteriosis rates. However, no previous studies have evaluated the association between community risk factors and campylobacteriosis rates across multiple U.S. states.MethodsWe obtained Campylobacter case data (2004–2010; n = 40,768) from the Foodborne Diseases Active Surveillance Network (FoodNet) and socioeconomic and environmental data from the 2010 Census of Population and Housing, the 2011 American Community Survey, and the 2007 U.S. Census of Agriculture. We linked data by zip code and derived incidence rate ratios using negative binomial regression models.ResultsCommunity socioeconomic and environmental factors were associated with both lower and higher campylobacteriosis rates. Zip codes with higher percentages of African Americans had lower rates of campylobacteriosis (incidence rate ratio [IRR]) = 0.972; 95 % confidence interval (CI) = 0.970,0.974). In Georgia, Maryland, and Tennessee, three leading broiler chicken producing states, zip codes with broiler operations had incidence rates that were 22 % (IRR = 1.22; 95 % CI = 1.03,1.43), 16 % (IRR = 1.16; 95 % CI = 0.99,1.37), and 35 % (IRR = 1.35; 95 % CI = 1.18,1.53) higher, respectively, than those of zip codes without broiler operations. In Minnesota and New York FoodNet counties, two top dairy producing areas, zip codes with dairy operations had significantly higher campylobacteriosis incidence rates (IRR = 1.37; 95 % CI = 1.22, 1.55; IRR = 1.19; 95 % CI = 1.04,1.36).ConclusionsCommunity socioeconomic and environmental factors are important to consider when evaluating the relationship between possible risk factors and Campylobacter infection.

Presence of animal feeding operations and community socioeconomic factors impact salmonellosis incidence rates: An ecological analysis using data from the Foodborne Diseases Active Surveillance Network (FoodNet), 2004–2010

Nontyphoidal Salmonella spp. are a leading cause of foodborne illness. Risk factors for salmonellosis include the consumption of contaminated chicken, eggs, pork and beef. Agricultural, environmental and socioeconomic factors also have been associated with rates of Salmonella infection. However, to our knowledge, these factors have not been modeled together at the community-level to improve our understanding of whether rates of salmonellosis are variable across communities defined by differing factors. To address this knowledge gap, we obtained data on culture-confirmed Salmonella Typhimurium, S. Enteritidis, S. Newport and S. Javiana cases (2004–2010; n=14,297) from the Foodborne Diseases Active Surveillance Network (FoodNet), and socioeconomic, environmental and agricultural data from the 2010 Census of Population and Housing, the 2011 American Community Survey, and the 2007 U.S. Census of Agriculture. We linked data by zip code and derived incidence rate ratios using negative binomial regressions. Multiple community-level factors were associated with salmonellosis rates; however, our findings varied by state. For example, in Georgia (Incidence Rate Ratio (IRR)=1.01; 95% Confidence Interval (CI)=1.005–1.015) Maryland (IRR=1.01; 95% CI=1.003–1.015) and Tennessee (IRR=1.01; 95% CI=1.002–1.012), zip codes characterized by greater rurality had higher rates of S. Newport infections. The presence of broiler chicken operations, dairy operations and cattle operations in a zip code also was associated with significantly higher rates of infection with at least one serotype in states that are leading producers of these animal products. For instance, in Georgia and Tennessee, rates of S. Enteritidis infection were 48% (IRR=1.48; 95% CI=1.12–1.95) and 46% (IRR=1.46; 95% CI=1.17–1.81) higher in zip codes with broiler chicken operations compared to those without these operations. In Maryland, New Mexico and Tennessee, higher poverty levels in zip codes were associated with higher rates of infection with one or more Salmonella serotypes. In Georgia and Tennessee, zip codes with higher percentages of the population composed of African Americans had significantly higher rates of infection with one or more Salmonella serotypes. In summary, our findings show that community-level agricultural, environmental and socioeconomic factors may be important with regard to rates of infection with Salmonella Typhimurium, Enteritidis, Newport and Javiana.

Understanding social media data for disaster management

Social media data are increasingly being used in disaster management for information dissemination, establishment of situational awareness of the “big picture” of the disaster impact and emerged incidences over time, and public peer-to-peer backchannel communications. Before we can fully trust the situational awareness established from social media data, we need to ask whether there are biases in data generation: Can we simply associate more tweets with more severe disaster impacts and therefore higher needs for relief and assistance in that area? If we rely on social media for real-time information dissemination, who can we reach and who has been left out? Due to the uneven access to social media and heterogeneous motivations in social media usage, situational awareness based on social media data may not reveal the true picture. In this study, we examine the spatial heterogeneity in the generation of tweets after a major disaster. We developed a novel model to explain the number of tweets by mass, material, access, and motivation (MMAM). Empirical analysis of tweets about Hurricane Sandy in New York City largely confirmed the MMAM model. We also found that community socioeconomic factors are more important than population size and damage levels in predicting disaster-related tweets.

Abstract MP61: Comparing the Influence of Individual vs. Community Socioeconomic Factors on Cardiovascular Health

BACKGROUND: Despite advances in treatment and decreases in risk factors, cardiovascular disease remains the cause of 1/3 deaths. Both prevalence and cost of cardiovascular disease are expected to increase over the coming decades. In supporting health efforts to reduce cardiovascular disease burden, the AHA developed a comprehensive cardiovascular health index (CVHI) incorporating behavioral and biological factors. A thorough understanding of health determinants requires inclusion of factors at multiple levels of proximity to individuals and communities. The objective of this study was to identify the demographic characteristics of individuals and areas in which they live that promote cardiovascular health. METHODS: Data from 2011 BRFSS were used to calculate CVHI. Participants were ineligible if missing information necessary to calculate CVHI (n = 156,973), if pregnant or pregnancy status was unknown (n = 3,693), or if missing county code (n = 37,163). Poisson model was used to determine change in the expected number of ideal factors an individual had due to various individual and county demographic characteristics. County demographic variables were abstracted from the Area Health Resource File. RESULTS: The effect of a 10 year increase in an individual’s age decreased the expected number of ideal CVHI factors by 6.31% (6.14, 6.47). Females had a 12.09% (11.48, 12.70) increase in expected number of ideal CVHI factors over males. Non-Hispanic blacks had a 7.42% (6.39, 8.44) decrease in expected number of ideal CVHI factors compared to other race/ethnicities. An individual’s education and income level had a dose response association with CVHI. Compared to having less than a high school education, those with a high school education had a 5.15% increase in the expected number of ideal CVHI factors and an 11.64% increase for those with a 4 year degree. As an individual’s income category increased there was a 7.89%, 10.79%, and 16.34% increase respectively in the expected number of ideal CVHI factors. For county demographics increases in the expected number of ideal factors was seen with increases in Hispanic population (0.93% per 10% increase) and increasing socioeconomic index (0.14% per 10 unit increase). A 10% increase in the population with no health insurance decreased the expected number of factors 1.49% (0.75, 2.22). There was a significant interaction (p &lt;0.01) between an individual’s income level and the socioeconomic status of the county lived in, with those in lower income categories benefiting more from living in higher socioeconomic areas than those with higher incomes. In conclusion, both individual and county demographic characteristics were associated with changes in an individual’s CVHI. CONCLUSION: This information can assist public health and government agencies in developing priorities and evaluating the potential effectiveness of policies and programs.

Socioeconomic and Racial Disparities of Pediatric Invasive Pneumococcal Disease After the Introduction of the 7-valent Pneumococcal Conjugate Vaccine

Racial differences have been well described for invasive pneumococcal disease (IPD), but little information exists on how race interacts with community socioeconomic factors. The Active Bacterial Core surveillance/Emerging Infections Program performed active surveillance for IPD in the 20-county Metropolitan Atlanta area. All IPD cases among children younger than 5 years from 2001 to 2009 were geocoded and linked to census tract-level socioeconomic measures from the 2000 US Census. Race- and socioeconomic-specific average annual incidence rates per 100,000 population were calculated. Trends in IPD incidence were determined by χ² tests for trend. Rate ratios (RRs) and 95% confidence intervals (CIs) were estimated using Poisson regression. IPD incidence among the total population of children increased as percentage of household poverty increased (P = 0.002), as median household income decreased (P < 0.001), as wealth decreased (P = 0.018) and as percentage of individuals with less than a high school education increased (P = 0.023). After stratifying by race, there was no significant linear trend between socioeconomic characteristics and IPD incidence among white children; among black children, however, IPD incidence decreased as socioeconomic conditions worsened. Despite adjusting for sex and socioeconomic factors, the IPD rate remained higher among black children compared with white children (RR = 1.60; 95% CI: 1.39-1.84). Differences in RR of IPD associated with highest poverty and lowest wealth noted in 2001 [RR = 2.71 (95% CI: 2.17-3.39) and 1.80 (95% CI: 1.09-2.96), respectively] declined in 2009 [RR = 1.33 (95% CI: 0.90-1.96) and 0.76 (95% CI: 0.48-1.19), respectively]. Although socioeconomic disparities in IPD incidence exist among children, the association between socioeconomic characteristics and IPD rates may differ by race and may change over time. Community-level socioeconomic factors did not account for racial differences in IPD incidence.

Impact of Rurality, Broiler Operations, and Community Socioeconomic Factors on the Risk of Campylobacteriosis in Maryland

We evaluated the combined impact of community-level environmental and socioeconomic factors on the risk of campylobacteriosis. We obtained Campylobacter case data (2002-2010; n = 3694) from the Maryland Foodborne Diseases Active Surveillance Network. We obtained community-level socioeconomic and environmental data from the 2000 US Census and the 2007 US Census of Agriculture. We linked data by zip code. We derived incidence rate ratios by Poisson regressions. We mapped a subset of zip code-level characteristics. In zip codes that were 100% rural, incidence rate ratios (IRRs) of campylobacteriosis were 6 times (IRR = 6.18; 95% confidence interval [CI] = 3.19, 11.97) greater than those in urban zip codes. In zip codes with broiler chicken operations, incidence rates were 1.45 times greater than those in zip codes without broilers (IRR = 1.45; 95% CI = 1.34, 1.58). We also observed higher rates in zip codes whose populations were predominantly White and had high median incomes. The community and environment in which one lives may significantly influence the risk of campylobacteriosis.

It’s not just who you are but where you live: An exploration of community influences on individual HIV status in rural Malawi

Approximately 1 million people are infected with Human Immunodeficiency Virus (HIV) in Malawi. Despite efforts aimed at changing individual risk behaviors, HIV prevalence continues to rise among rural populations. Both previous research and the Political Economy of Health framework suggest that community-based socio-economic factors and accessibility may influence HIV transmission; however, these community factors have received little empirical investigation. To fill this gap, this research uses data from a nationally representative probability sample of rural Malawians combined with small area estimates of community socio-economic and accessibility data in logistic regression models to: 1) reveal relationships between community factors and individual HIV status; 2) determine whether these relationships operate through individual HIV risk behaviors; and 3) explore whether these associations vary by gender. Community socio-economic factors include relative and absolute poverty; community accessibility factors include distance to roads, cities, and public health facilities. Individual HIV risk behaviors include reported condom use, sexually transmitted infections, multiple partnerships, and paid sex. Results show that higher community income inequality, community proximity to a major road, and community proximity to a public health clinic are associated with increased odds of HIV for women. For men, community proximity to a major road and community proximity to a public health clinic are associated with increased odds of HIV infection. These direct relationships between community factors and individual HIV status are not mediated by individual HIV risk behaviors. The Political Economy of Health frames the discussion. This study provides evidence for expanding HIV prevention efforts beyond individual risk behaviors to consideration of community factors that may drive the HIV epidemic in rural Malawi.

The ecology of race and socioeconomic distress: Infant and working-age mortality in Chicago

We examine the effects of education, unemployment, and racial segregation on age-, sex-, and race-specific mortality rates in racially defined Chicago community areas from 1989 to 1991. Community socioeconomic factors account for large observed areal variations in infant and working-age mortality, but especially working-age mortality for the black population. For black men, the mortality consequences of living in economically distressed communities are quite severe. Segregation effects on mortality are more modest and largely operate through neighborhood socioeconomic conditions, although some direct effects of segregation on mortality for blacks are apparent.