Concentrations Of Black Residents Research Articles

Why do lower-income areas experience worse road safety outcomes? Examining the role of the built environment in Orange County, Florida

Lower-income areas experience an increased incidence of traffic crashes, injuries, and deaths than more affluent ones. Researchers tend to blame these outcomes on differences in car ownership, with lower-income households expected to use vulnerable active modes at higher rates, as well as being more likely to drive older vehicles with fewer safety features. While these explanations seem plausible enough, they likely fail to provide a complete picture of the problem. This study examines the role of the built environment in road safety outcomes for lower- and higher-income block groups in Orange County, Florida. It finds that the hazard posed by urban arterials is three times greater for lower-income environments than for more affluent communities. Sidewalk buffers, ordinarily regarded as a pedestrian amenity, were associated with crash increases in affluent areas but not lower-income ones. Areas with concentrations of black residents were found to be increased risk, even after accounting for differences in income. Considered as a whole, the risk factors for lower-income and high-income populations are not the same. This article examines the underlying reasons that lead to these outcomes and discusses the need to better account for the manner in which design may uniquely affect the safety of different demographic cohorts.

Trends in family ratings of experience with care and racial disparities among Maryland nursing homes.

Providing equitable and patient-centered care is critical to ensuring high quality of care. Although racial/ethnic disparities in quality are widely reported for nursing facilities, it is unknown whether disparities exist in consumer experiences with care and how public reporting of consumer experiences affects facility performance and potential racial disparities. We analyzed trends of consumer ratings publicly reported for Maryland nursing homes during 2007-2010, and determined whether racial/ethnic disparities in experiences with care changed during this period. Multivariate longitudinal regression models controlled for important facility and county characteristics and tested changes overall and by facility groups (defined based on concentrations of black residents). Consumer ratings were reported for: overall care; recommendation of the facility; staff performance; care provided; food and meals; physical environment; and autonomy and personal rights. Overall ratings on care experience remained relatively high (mean=8.3 on a 1-10 scale) during 2007-2010. Ninety percent of survey respondents each year would recommend the facility to someone who needs nursing home care. Ratings on individual domains of care improved among all nursing homes in Maryland (P<0.01), except for food and meals (P=0.827 for trend). However, site-of-care disparities existed in each year for overall ratings, recommendation rate, and ratings on all domains of care (P<0.01 in all cases), with facilities more predominated by black residents having lower scores; such disparities persisted over time (P>0.2 for trends in disparities). Although Maryland nursing homes showed maintained or improved consumer ratings during the first 4 years of public reporting, gaps persisted between facilities with high versus low concentrations of minority residents.