Neighborhood Disadvantage Research Articles

Influence of Neighborhood Disadvantage and Individual Sociodemographic Conditions on Heart Failure Self-care.

Residence in socioeconomically disadvantaged neighborhoods and individual sociodemographic conditions contribute to worse heart failure (HF) outcomes and may influence HF self-care. However, associations between neighborhood disadvantage, socioeconomic conditions, and HF self-care are unclear. The purpose of this secondary analysis was to investigate whether neighborhood disadvantage and individual socioeconomic conditions predicted worse HF self-care. This study was a secondary analysis of baseline data from a mixed-method study of 82 adults with HF. Participant zip codes were assigned a degree of neighborhood disadvantage using the Area Deprivation Index. Those in the top 20% most disadvantaged neighborhoods (Area Deprivation Index ≥ 80) were compared with those in the least disadvantaged neighborhoods. The Self-Care of Heart Failure Index was used to measure self-care maintenance and monitoring. Multiple linear regression was conducted. Of all participants, 59.8% were male, 59.8% were persons of color, and the mean age was 64.87 years. Residing in a disadvantaged neighborhood and living alone predicted worse HF self-care maintenance and monitoring. Having no college education was also a predictor of worse HF self-care maintenance. Although persons of color were more likely to reside in disadvantaged neighborhoods, race was not associated with HF self-care. Residing in a disadvantaged neighborhood and living alone may be important risk factors for worse HF self-care. Differences in self-care cannot be attributed solely to the individual sociodemographic determinants of race, gender, age, annual household income, or marital status. More research is needed to understand the connection between neighborhood disadvantage and HF self-care.

Getting out and giving back: repertoires of destigmatization in the private social safety net

Abstract Receiving assistance can be stigmatizing. As the cash welfare rolls have fallen to near-historic lows, the privatization of the social safety net in many states has brought up new questions about how recipients of assistance meet their material needs without sacrificing their sense of dignity. I draw on 15 months of ethnographic observation and 44 interviews with social service recipients in two majority Black neighborhoods in Houston, Texas to explore how they destigmatize their encounters with social service providers. I find that service recipients primarily seek out organizations that will treat them with respect due to the stigma attached to receiving assistance. This stigma is both racialized and gendered, such that groups with identities congruent with negative stereotypes about welfare recipients—like Black women—see themselves at higher risk of stigmatization and therefore practice destigmatization strategies with greater frequency. I build on these findings by highlighting two repertoires of destigmatization that service recipients draw upon to access both material and symbolic resources simultaneously: getting out of their neighborhoods to receive services anonymously and giving back by volunteering at local organizations. In doing so, I highlight multiple pathways through which residents of disadvantaged neighborhoods move from stigmatization to destigmatization in the welfare system.

Shared challenges, divergent practices. The impact of institutional frameworks on area-based initiatives in Barcelona and Paris

ABSTRACT In recent decades, the persisting inequalities in European cities have spurred the implementation of area-based initiatives (ABI) in the most disadvantaged neighbourhoods. This paper investigates how the interplay between diverse institutional frameworks and housing ownership regimes influences the design and execution of ABI policies in France and Spain. Focusing on the specific cases of Pla de Barris in Barcelona and Contrat de Ville in Paris, the study elucidates the strengths and limitations of different urban renewal strategies, emphasizing the imperative of a multi-level governance approach for effective ABIs.

Social determinants of health and outcome disparities in spine tumor surgery. Part 2: Neighborhood disadvantage and long-term outcomes.

Neighborhood-level resource disadvantage has been previously shown to predict extent of resection, oncological follow-up, adjuvant treatment, and clinical trial participation for malignancies, including glioblastoma. The authors aimed to characterize the association between neighborhood disadvantage and long-term outcomes after spine tumor surgery. The authors analyzed all patients who underwent surgery for primary or secondary (all metastatic pathologies) spine tumors at a single spinal oncology specialty center in the United States from 2015 to 2022. The Area Deprivation Index (ADI), a validated metric compositing 17 social determinants of health variables that ranges continuously from 0% (higher advantage) to 100% (higher disadvantage), was used to quantify neighborhood disadvantage. Patient addresses were matched to ADI on the basis of the census block of residence. Subsequently, the study population was dichotomized into advantaged (ADI 0%-33%) and disadvantaged (ADI 34%-100%) cohorts. The primary endpoint was functional status, as defined by Eastern Cooperative Oncology Group (ECOG) Performance Status Scale grade, with secondary endpoints including inpatient outcomes, mortality, readmissions, reoperations, and clinical research participation. Multivariable logistic, gamma log-link, and Cox regression adjusted for 14 confounders, including patient and oncological characteristics, general and tumor-related presenting severity, and treatment. In total, 237 patients underwent spine tumor surgery from 2015 to 2022, with an average age of 53.9 years, and 57.0% had primary tumors whereas 43.0% had secondary tumors; 55.3% (n = 131) were classified by ADI into the disadvantaged cohort. This cohort had higher rates of ambulation deficits on presentation (39.1% vs 23.5%, p = 0.015) and nonelective surgery (35.1% vs 23.6%, p = 0.030). Postoperatively, disadvantaged patients exhibited higher odds of residual tumor (OR 2.55, p = 0.026), especially for secondary tumors (OR 4.92, p = 0.045). Patients from disadvantaged neighborhoods additionally exhibited significantly higher odds of poor functional status at follow-up (OR 3.94, p = 0.002). Postoperative survival was 74.7% (mean follow-up 17.6 months), with the disadvantaged cohort experiencing significantly shorter survival (HR 1.92, p = 0.049). Moreover, this population had higher odds of readmission (OR 1.92, p = 0.046) and, for primary tumors, reoperation (OR 9.26, p = 0.005). Elective participation in prospective clinical research was lower among the disadvantaged cohort (OR 0.45, p = 0.016). Neighborhood disadvantage predicts higher rates of residual tumor, readmission, and reoperation, as well as poorer functional status, shorter postoperative survival, and decreased elective research participation. The ADI may be used to risk stratify spine oncology patients and guide targeted interventions to ameliorate neurosurgical disparities and to reduce barriers to research participation.

Neighborhood racial income inequality and cognitive health.

Neighborhood socioeconomic status (SES) has been linked to dementia, but the distribution of SES within a neighborhood may also matter. Data from 460 (47% Black, 46% White) older adults from the Michigan Cognitive Aging Project were linked to census tract-level data from the National Neighborhood Data Archive (NaNDA). Neighborhood SES included two composites reflecting disadvantage and affluence. Neighborhood racial income inequality was the ratio of median incomes for White versus Black residents. Generalized estimating equations examined associations between neighborhood factors and cognitive domains. Neighborhood racial income inequality was uniquely associated with worse cognitive health, and these associations did not differ by participant race. Neighborhood disadvantage was only associated with worse cognitive health among Black participants. Both the level and racial distribution of SES within a neighborhood may be relevant for dementia risk. Racial differences in the level and impact of neighborhood SES contribute to dementia inequalities. Black participants lived in neighborhoods with lower socioeconomic status (SES) than White participants, on average. Neighborhood SES and racial income inequality were associated with worse cognition. Effects of neighborhood racial income inequality did not differ across racial groups. Effects of neighborhood SES were only evident among Black participants.

Development of Composite Measures of Neighborhood Economic Factors for Use in Spinal Cord Injury Outcomes Studies: A Spinal Cord Injury Model Systems Database Study

ObjectiveTo develop composite measures of neighborhood economic factors for use with the national Spinal Cord Injury Model Systems (SCIMSs) database in cross-sectional and longitudinal investigations of the social determinants of health. DesignSecondary data analysis of administrative data from the 2009, 2014, and 2019 American Community Survey (ACS) 5-year estimates and survey data collected for the SCIMS database. SettingCommunity. ParticipantsThe validity of the neighborhood economic measures developed from the ACS data was tested with a sample of SCIMS participants who completed a follow-up interview between 2017 and 2021 (N=8,130). The predictive validity of the neighborhood measures was assessed with a subsample of cases with complete data on the outcome and covariate measures (N=6,457). InterventionsNot applicable. Main Outcome MeasuresA binary measure of self-rated health status (1=poor/fair health; 0=good/very good/excellent). ResultsA combination of panel review and data reduction techniques yielded 2 distinct measuring neighborhood socioeconomic status (SES) and neighborhood socioeconomic disadvantage that were validated using 3 waves of ACS data and the SCIMS data. The odds of reporting poor health were lower among people living in moderate- and high-SES neighborhoods and highest among people living in moderately and highly disadvantaged neighborhoods. The negative association between neighborhood SES and poor health was fully attenuated by differences in participants’ individual demographic and economic characteristics whereas the positive association between neighborhood disadvantage and poor health persisted after adjusting for individual differences. ConclusionsThe two composite measures of neighborhood economic factors developed by this study are robust in samples from different periods of time and valid for use with the SCIMS database. Future investigations conducting surveillance of the needs of the SCI population using this resource may consider using these measures to assess the effect of the social determinants of health in outcomes after SCI.

Neighborhood-Level Disparities in Hypertension Prevalence and Treatment Among Middle-Aged Adults

Hypertension in middle-aged adults (35-50 years) is associated with poorer health outcomes in late life. Understanding how hypertension varies by race and ethnicity across levels of neighborhood disadvantage may allow for better characterization of persistent disparities. To evaluate spatial patterns of hypertension diagnosis and treatment by neighborhood socioeconomic position and racial and ethnic composition. In this cross-sectional study of middle-aged adults in Cuyahoga County, Ohio, who encountered primary care in 2019, geocoded electronic health record data were linked to the area deprivation index (ADI), a neighborhood disadvantage measure, at the US Census Block Group level (ie, neighborhood). Neighborhoods were stratified by ADI quintiles, with the highest quintile indicating the most disadvantage. Data were analyzed between August 7, 2023, and June 1, 2024. Essential hypertension. The primary outcome was a clinician diagnosis of essential hypertension. Spatial analysis was used to characterize neighborhood-level patterns of hypertension prevalence and treatment. Interaction analysis was used to compare hypertension prevalence by racial and ethnic group within similar ADI quintiles. A total of 56 387 adults (median [IQR] age, 43.1 [39.1-46.9] years; 59.8% female) across 1157 neighborhoods, which comprised 3.4% Asian, 31.1% Black, 5.5% Hispanic, and 60.0% White patients, were analyzed. A gradient of hypertension prevalence across ADI quintiles was observed, with the highest vs lowest ADI quintile neighborhoods having a higher hypertension rate (50.7% vs 25.5%) and a lower treatment rate (61.3% vs 64.5%). Of the 315 neighborhoods with predominantly Black (>75%) patient populations, 200 (63%) had a hypertension rate greater than 35% combined with a treatment rate of less than 70%; only 31 of 263 neighborhoods (11.8%) comprising 5% or less Black patient populations met this same criterion. Compared with a spatial model without covariates, inclusion of ADI and percentage of Black patients accounted for 91% of variation in hypertension diagnosis prevalence among men and 98% among women. Men had a higher prevalence of hypertension than women across race and ADI quintiles, but the association of ADI and hypertension risk was stronger in women. Sex prevalence differences were smallest between Black men and women, particularly in the highest ADI quintile (1689 [60.0%] and 2592 [56.0%], respectively). These findings show an association between neighborhood deprivation and hypertension prevalence, with disparities observed particularly among Black patients, emphasizing a need for structural interventions to improve community health.

Territory and lack of water access: an educational experience in disadvantaged neighborhoods in Turbo, Antioquia (Colombia)

RESUMEN Esta reflexión emerge de un proyecto educativo orientado a mejorar algunos aspectos relacionados con el acceso y manejo del agua en tres barrios informales. El objetivo es reflexionar acerca de las nociones de territorio que se construyen en el contexto de proyectos educativos en comunidades que habitan barrios informales. El proyecto inició con la conformación de un grupo de participantes quienes realizaron la cartografía social de sus barrios para identificar aspectos críticos sobre agua y saneamiento. La validación de los mapas y los recorridos por cada sector aportaron elementos para los talleres relacionados con acceso, manejo, cuidado y derecho al agua, que posteriormente fueron multiplicados en cada comunidad. Este proceso permitió reconocer situaciones relacionadas con la negación del derecho al agua, el malestar, la tensión entre ilegalidad e informalidad, las maneras en que las comunidades resuelven sus necesidades y las relaciones que establecen con su territorio, en medio de grandes inequidades. En conclusión, existe una relación profunda entre salud y territorio, que se hace más evidente en comunidades en condiciones críticas. Los proyectos de educación para la salud requieren hacer un trabajo situado y establecer una mirada interdisciplinaria, que reconozca la complejidad e interdependencia de las dinámicas sociales y ambientales.

Quantifying the association between doula care and maternal and neonatal outcomes

BackgroundThe US suffers from an increasing rate of severe maternal morbidity, paired with a wide disparity in maternal health by race. Doulas are posited to be a useful resource to increase positive outcomes and decrease this disparity. ObjectiveEvaluate the association of doula care with a broad range of maternal and neonatal outcomes in various subpopulations. Study DesignRetrospective cohort of deliveries from 1/2021-12/2022 at a single institution receiving prenatal care. Exposure was receipt of doula care prenatally and at delivery. We evaluated both maternal (cesarean delivery, cesarean delivery of nulliparous, term, singleton, vertex infant, vaginal birth after cesarean (VBAC), gestational hypertension, preeclampsia, postpartum emergency department visit, readmission and attendance at postpartum office visit) and neonatal (neonatal intensive care unit admission, unexpected complications in term newborns, breastfeeding, preterm delivery, and intrauterine fetal growth restriction) outcomes. Because our institution previously employed targeted outreach, offering doula services to patients at highest risk, we utilized multiple methods to generate an appropriate comparison population. We conducted multivariate logistic regression and conditional regressions using propensity scores, modeling likelihood of doula care, to generate adjusted risk differences associated with doula care. Analyses were repeated in populations stratified by race (White/Black) then payor status (public/commercial). ResultsOur cohort included 17,831 deliveries; 486 with doula care and 17,345 without. Patients receiving doula care were more likely to self-report Black race, be publicly insured, and live in a more disadvantaged neighborhood. Regardless of analytic approach, for every 100 patients under doula care there were 15-34 more VBACs [adjRD 15.6 (95%CI: 3.8, 27.4); adjRD 34.2 (95%CI: 0.046, 68.0)] and 5-6 more patients attending a postpartum office visit [adjRD 5.4 (95%CI: 1.4, 9.5); adjRD 6.8 (95% CI:3.7, 9.9)] compared with those not receiving doula services.Infants born to these patients were 20% more like likely to be exclusively breastfed [adjRR 1.22 (95%CI: 1.07, 1.38)], and doula care was associated with 3-4 fewer preterm births [adjRD -3.8 (95%CI: -6.1, -1.5); -4.0 (95%CI: -6.2, -1.8)] for every 100 deliveries receiving doula care. Results were consistent regardless of race or insurance. Results were also consistent when doula care was redefined as having at least 3 prenatal encounters with a doula. ConclusionsDoula care was associated with more VBACs, attendance at postpartum office visit, breastfeeding, and fewer preterm deliveries. The effect of doula care was consistent across race and insurance status.

Kim et al. Respond to "Dispersal policies, neighborhood disadvantage, and refugee health in a Nordic context".

Kim et al. Respond to "Dispersal policies, neighborhood disadvantage, and refugee health in a Nordic context".

Is the availability and quality of local early childhood education and care services associated with young children's mental health at school entry?

PurposeThis study investigated the relationship between geographic availability (and quality) of local early childhood education and care services and children's early mental health outcomes for all children entering their first year of full-time school in Melbourne, Australia. MethodsWe capitalise on a unique population linked dataset, the Australian Early Development Census – Built Environment, which combines geospatial measures of children's neighbourhoods with demographic information and child mental health outcomes for all school entrants in Australia's 21 most populous cities and towns. Objective early childhood education and care service location and quality exposures were developed for each study child based on home addresses. Four geographic availability exposures (counts within 3 km) were examined for cross-sectional associations with child mental health outcomes (externalising and internalising difficulties, competence). We estimated associations using multilevel logistic regression (Markov Chain Monte Carlo estimation) adjusting for child demographics and stratifying by urbanicity. ResultsChildren with higher counts of high-quality preschool services within 3 km of home had lower odds of difficulties and higher odds of competence. Overall, exposures were most consistently associated with children's competence. Across all outcomes, the most consistent patterning was observed for children living in the inner city and middle ring. Results varied depending on whether service quality was accounted for in measures of availability. Geographic availability of early childhood services showed patterning by neighbourhood disadvantage and by maternal education. ConclusionWe found some evidence that geographic availability of high-quality preschools was associated with better child mental health outcomes, but results varied by urbanicity. While future research is required to unpack these differences, these findings indicate the importance of accounting for both geographic availability and service quality simultaneously in future research, policy and practice.

Social cohesion as a modifier of joint air pollution exposure and incident dementia

Social cohesion can reduce stress, increase social interaction, and improve cognitive reserve. These social mechanisms may modify the effects of air pollution on dementia risk. This cohort study examines the potential moderating effect of social cohesion on associations between joint air pollution exposure and incident dementia leveraging data from 5112 community-dwelling adults ≥65 years of age enrolled in the National Health and Aging Trends Study (NHATS). Study participants were enrolled in 2011 and followed through 2018. We assigned 2010 residential census tract-level exposures to five air pollutants, particulate matter (PM) ≤ 10 μm in diameter, PM ≤ 2.5 μm in diameter, carbon monoxide, nitric oxide, and nitrogen dioxide, using the US Environmental Protection Agency's Community Multiscale Air Quality Modeling System. Dementia status was determined based on self- or proxy-reported dementia diagnosis or “probable dementia” according to NHATS cognitive screening tools. Participants' self-rated neighborhood social cohesion was evaluated based on three questions: neighbors knowing each other, being helpful, and being trustworthy. Social cohesion was dichotomized at the median into high vs low social cohesion. Associations between air pollutants and incident dementia were assessed using quantile g-computation Cox proportional hazard models and stratified by high vs low social cohesion, adjusting for age, sex, education, partner status, urbanicity, annual income, race and ethnicity, years lived at current residence, neighborhood disadvantage index, and tract segregation. High social cohesion (HR = 1.20, 95 % CI = 0.98, 1.47) and air pollution (HR = 1.08, 95 % CI = 0.92, 1.28) were not associated with incident dementia alone. However, when stratified, greater joint air pollution exposure increased dementia risk among participants at low (HR = 1.34, 95 % CI = 1.04, 1.72), but not high (HR = 1.00, 95 % CI = 0.93, 1.06) social cohesion. Air pollution was a risk factor for dementia only when reported social cohesion was low, suggesting that social interaction may play a protective role, mitigating dementia risk via air pollution exposure.

Dispersal policies, neighborhood disadvantage, and refugee health in a Nordic context.

In this issue of the journal, Kim et al. (Am J Epidemiol 0000;000(00):0000-0000) examine whether neighborhood disadvantage is associated with cardiovascular disease risk in Denmark. A potential contribution of their article is the study of mediators (cumulative income, unstable employment, and poor mental health) underlying the association using a quasi-experimental design based on a Danish dispersal policy. In this commentary, I will draw attention to some potential limitations involving using refugee dispersal policies as natural experiments. I will further discuss the extent to which the mediators studied by Kim et al. contribute to our overall understanding of mechanisms linking neighborhood disadvantage and cardiovascular disease (CVD) risk. However, as a similar dispersal policy was introduced during the same time period in a country neighboring Denmark - Sweden - I will also take the opportunity to give an account of the background of dispersal policies in the two countries and offer some general reflections on their consequences for refugee integration and well-being there.

The Role of Neighborhood Socioeconomic Status in Institutionalization of Home Health Care Patients With and Without Alzheimer's Disease and Related Dementias

ObjectivesTo assess whether neighborhood socioeconomic status (SES) moderates the association between Alzheimer's disease and related dementias (ADRD) and successful discharge to the community. In addition, to explore whether the role of neighborhood SES on successful discharge for patients with ADRD varies by the severity of ADRD. DesignThis is a retrospective cohort study. Setting and ParticipantsMedicare Fee-for-service beneficiaries, aged 65 or older, who received home health care in 2019. MethodsWe used linear probability regression models with successful discharge to the community as the main outcome, and neighborhood SES and ADRD as independent variables. Also, we modified the Functional Assessment Staging Tool (FAST) to measure ADRD severity. ResultsOur study results show ADRD and residing in neighborhoods with lower socioeconomic conditions were independently associated with lower probabilities of successful discharge to the community. We also found that the differences in probabilities of remaining at home between patients with and without ADRD were larger among those in neighborhoods with lower SES (ADRD∗less disadvantaged neighborhood, coeff: −0.01, P < .001; ADRD∗more disadvantaged neighborhood, coeff: −0.02, P < .001; ADRD∗most disadvantaged neighborhood, coeff: 0.032, P < .001). Among patients with ADRD, patients with the most advanced ADRD were less likely to remain in their homes and community when living in neighborhoods with lower SES. Conclusions and ImplicationsOur study results show that when patients with ADRD receiving home health care live in neighborhoods with lower SES, they face further challenges to remaining in their homes and community. Public health officials and community planners should consider using area-level interventions to improve care and health outcomes for patients with ADRD. Also, further research aimed at identifying the specific factors and resources influencing lower care quality and poorer health outcomes in socioeconomically disadvantaged neighborhoods, particularly for patients with ADRD, can provide valuable insights for the development and implementation of targeted interventions.

Behavioral Health Workforce Distribution in Socially Disadvantaged Communities.

This study sought to understand the geographic distribution of three behavioral health clinician (BHC) types in disadvantaged communities in the U.S. across a standardized index of area disadvantage. CMS National Plan and Provider Enumeration System's data were used to identify BHC practice addresses. Addresses were geocoded and mapped to census block groups across Area Disadvantage Index (ADI) scores. Differences in the proportion of BHCs per 100k people in a block group by ADI, clinician type, and rurality were compared. Zero-inflated negative binomial models assessed associations between ADI score with any amount, and expected count, of BHC type in a block group. The sample included 836,780 BHCs (51.5% counselors, 34.5% social workers, 14.0% psychologists). Results indicated there were fewer BHCs in areas of high disadvantage with 351 BHCs in the lowest need versus 267 BHCs in highest need areas, per 100k people. BHCtype was differently associated with the rate of clinicians per 100k by ADI and block groups that were both rural and high ADI had the least BHCs located. Findings suggest the maldistribution of BHCs by ADI underscores how some BHCs may be better positioned to meet the needs of vulnerable communities. Increasing access to behavioral health care requires a workforce equitably positioned in high-need areas. Reforms to payment and practice regulations may support BHCs to deliver services in socially disadvantaged neighborhoods.

Preference for internet at home in a disadvantaged neighbourhood

Although most households are equipped with digital information and communication technologies (DICT), a significant digital divide remains in internet access at home along income and digital native/immigrant status. Previous research has mainly investigated whether this digital inequality is attributable to constraints such as technological availability or financial resources. This article examines the extent to which digital inequality of internet access at home is preference-driven by comparing internet preference with other housing preferences and investigating the effect heterogeneity of social status on internet preference. We analyse a dataset comprising 131 residents of a disadvantaged neighbourhood in Bochum, Germany. This neighbourhood provides a suitable setting, as internet access is available throughout the area but varies between individual households. Using a factorial survey with housing vignettes, we assess the importance of internet preference. This research design circumvents many of the difficulties in measuring housing preferences, such as unrealistic wishful thinking, and facilitates the investigation of effect heterogeneity in terms of social status characteristics. The results show that the preference for internet access at home is comparable to that of other housing amenities and does not vary according to age, income or the presence of children. The findings reinforce the importance of the financial constraint-driven causes of the digital divide.

Greater Neighborhood Disadvantage Is Associated with Alterations in Fetal Functional Brain Network Structure

To determine the association between neighborhood disadvantage (ND) and functional brain development of in utero fetuses. We conducted an observational study using Social Vulnerability Index (SVI) scores to assess the impact of ND on a prospectively recruited sample of healthy pregnant women from Washington, DC. Using 79 functional magnetic resonance imaging scans from 68 healthy pregnancies at a mean gestational age of 33.12weeks, we characterized the overall functional brain network structure using a graph metric approach. We used linear mixed effects models to assess the relationship between SVI and gestational age on 5 graph metrics, adjusting for multiple scans. Exposure to greater ND was associated with less well integrated functional brain networks, as observed by longer characteristic path lengths and diminished global efficiency (GE), as well as diminished small world propensity (SWP). Across gestational ages, however, the association between SVI and network integration diminished to a negligible relationship in the third trimester. Conversely, SWP was significant across pregnancy, but the relationship changed such that there was a negative association with SWP earlier in the second trimester that inverted around the transition to the third trimester to a positive association. These data directly connect ND and altered functional brain maturation in fetuses. Our results suggest that, even before birth, proximity to environmental stressors in the wider neighborhood environment are associated with altered brain development.

Area Deprivation Index and Frailty Among Older People With HIV.

We evaluated the relationship between neighborhood disadvantage (measured by the Area Deprivation Index [ADI]) and frailty. We performed a secondary analysis, pooling cross-sectional data collected from 209 people with HIV (PWH) aged ≥50years enrolled in studies in Colorado (CO) and Missouri (MO). MO participants (N = 137) had a higher ADI (µ= 70, ơ2 = 25) compared to CO (µ= 32, ơ2 = 15; p < .001). No significant differences in ADI were observed between frailty categories when cohorts were examined either separately or combined; however, when comparing individual frailty criteria, the most apparent differences by neighborhood disadvantage were seen among those with limited physical activity (μ = 67, ơ2 = 28) compared to those without (μ = 55, ơ2 = 29, p = .03). Neighborhood disadvantage was associated with low physical activity but not with overall frailty status. Future research should examine how access to physical activity spaces varies based on ADI, as this could be crucial in preventing frailty.

Predictors of medical adherence following a bowel management program for youth and young adults with Spina Bifida.

To evaluate individual and community sociodemographic factors that predict bowel regimen adherence in youth and young adults with Spina Bifida (SB) following participation in a bowel management program (BMP). Participants were drawn from clinical cases seen through an International Center for Colorectal and Urogenital Care. Area deprivation index (ADI) scores were extracted from participant addresses and bowel regimen adherence data were collected from the electronic medical record (EMR). Participants' mean age was 8.06years old, 51.7% were male, 72.4% white, 37.9% Hispanic, 56.9% government insurance, 89.7% myelomeningocele, 15.5% non-adherent. Average neighborhood disadvantage was 5.19 (SD:2.83, range:1-10). After controlling for variables correlated with adherence (p < .20), every one decile higher neighborhood disadvantage score was associated with a 48% decrease in the odds of being adherent (OR = 0.52, p = .005, 95% CI: -101.90, -0.21). Our results suggest that neighborhood disadvantage is a strong predictor of medical adherence following a BMP, more so than other sociodemographic and health-related variables. These results may assist with identifying which individuals may be at higher risk for poor health outcomes due to neighborhood socioeconomic disadvantage and help health care systems intervene proactively.

Social support moderates association between area deprivation index and changes in physical health among adults in the Baltimore Study of Black Aging (BSBA)

ABSTRACT Despite the association of neighborhood quality with poorer adult health, limited research has explored the association between neighborhood disadvantage, e.g. Area Deprivation Index (ADI), and older Black adults’ health, prospectively. This observational study examined the association between ADI and changes in longitudinal physical health within older Black adults. The analytic sample (n = 317) included data from waves 1 & 2 of the Baltimore Study of Black Aging: Patterns of Cognitive Aging (BSBA-PCA). Study variables included the Area Deprivation Index (ADI), objective (e.g. average heart rate) and subjective (e.g. activities of daily living) measures of physical health. Multiple linear regression models were conducted controlling for sociodemographic and social support characteristics. Participants living in more disadvantaged neighborhoods, based on national and state ADIs, were more likely to have a decreasing heart rate even after adjusting for covariates. Likewise, participants reporting increasing levels of ADL difficulty were living in a neighborhood with greater disadvantage based on national and state ADI rankings. Significant social support received and ADI (national and state) interactions were observed for average heart rate. The findings suggest that research on the effect of neighborhood quality and social support can enhance our understanding of its impact on older Black adults’ health prospectively.