Neighborhood Disadvantage Research Articles

884 Frailty and Socioeconomic Status Predict Outcome in Newly Diagnosed Glioblastoma Patients

INTRODUCTION: Identification of molecular markers of glioblastoma (GBM) prognosis has not often led to meaningful intervention. Individual patient and socioeconomic factors are underexplored prognostic factors. Frailty, a measure of physiological vulnerability, and area deprivation, a measure of socioeconomic status, are easily obtained during the preoperative evaluation. Moreover, both are amenable to intervention; the medical conditions that contribute to frailty can be optimized prior to surgery, while barriers to health care (physical, financial, and cultural) can be addressed for patients at risk socioeconomically. METHODS: This is a retrospective review of patients with newly diagnosed GBM undergoing surgery from 2015 through 2020. Demographic and tumor specific data were recorded. Additionally, the 5-factor modified frailty index (mFI-5) and national area deprivation index (ADI) were determined for each patient. RESULTS: There were 244 patients. Compared to patients in the “some or no” frailty category, patients with “significant” frailty had a shorter median survival: 273 days (95% CI 126-339) vs 393 days (95% CI 317-458), p = 0.008. The median survival for patients living in the most disadvantaged neighborhoods, 210 days (95% CI 134-334), is significantly lower than for those living in the least, 384 days (95% CI 239-484), p = 0.17. Twenty-five percent of patients living in the most disadvantaged neighborhoods did not receive postoperative chemoradiation compared to 11% of patients in the least disadvantaged neighborhoods, p=0.046. Similarly, patients of color were less likely to receive standard of care chemoradiation than white patients. CONCLUSIONS: Both increasing frailty and neighborhood disadvantage are associated with worse outcome in newly diagnosed GBM patients undergoing surgery. Patients living in the most deprived neighborhoods and patients of color are less likely to receive postoperative chemoradiation. Identification of non-traditional predictors of treatment and outcome will lead to mitigation strategies.

Food Insecurity, Neighborhood, and Health Care Utilization in Health System Adults

To (1) explore relationships among food insecurity, neighborhood disadvantage, and health care utilization in adults from a single health system and (2) determine whether food insecurity and neighborhood disadvantage predict acute health care utilization within 90 days of hospital discharge. A retrospective, correlational design with a single cohort. Data were analyzed from health system administrative billing databases, electronic health records, and publicly available population databases. Multivariable negative binomial regression was performed to assess the association between factors of interest and acute health care utilization within 90 days of index hospital discharge. In 41,566 records, 1.45% (n = 601) of patients reported food insecurity. The mean (SD) Area Deprivation Index score was 54.4 (26), indicating that the majority of patients lived in disadvantaged neighborhoods. Patients with food insecurity were less likely to have a provider office visit (P < .001) but were expected to have 2.1 times greater acute health care utilization within 90 days (incidence rate ratio [IRR], 2.12; 95% CI, 1.90-2.37; P < .001) compared with those without food insecurity. Living in a disadvantaged neighborhood had a small effect on acute health care utilization (IRR, 1.12; 95% CI, 1.08-1.17; P < .001). When considering social determinants of health for health system patients, food insecurity was a stronger predictor of acute health care utilization than was neighborhood disadvantage. Identifying patients with food insecurity and targeting appropriate interventions to high-risk populations may improve provider follow-up and acute health care utilization.

The development of youth antisocial behavior across time and context: A systematic review and integration of person-centered and variable-centered research.

Trajectories of youth antisocial behavior (ASB) are characterized by continuity and change. Although numerous longitudinal studies have examined ASB, findings from person-centered and variable-centered research have not yet been integrated. The present paper integrates findings across statistical methods for a more comprehensive understanding of the development of ASB. Neighborhood disadvantage is considered as a core moderator. The study protocol was registered in the PROSPERO database of systematic reviews (registration number CRD42021255820). The PsycINFO and PubMed databases were examined (September 2022) to identify longitudinal studies of youth aggression and/or rule-breaking. Results from person-centered and variable-centered studies were integrated via narrative synthesis, and a systematic quality assessment was conducted. Of 8227 studies identified, 136 met inclusion criteria. Our review indicated that rule-breaking trajectories were largely distinguished by differences in rate of change (i.e., slope), whereas aggression trajectories differed more by baseline level (i.e., intercept), particularly in childhood. For adolescents in disadvantaged neighborhoods, however, aggression trajectories differed by both intercept and slope. The respective importance of the intercept and slope differed across dimensions of ASB, developmental stage, and neighborhood residence. Neighborhood disadvantage was associated with trajectories of aggression, consistent with developmental theories emphasizing the role of person-environment interactions.

PD32-11 IMPACT OF SOCIAL DETERMINANTS OF HEALTH ON CARE OF URETHRAL STRICTURES: A PILOT EVALUATION OF THE AREA DEPRIVATION INDEX

You have accessJournal of UrologyCME1 Apr 2023PD32-11 IMPACT OF SOCIAL DETERMINANTS OF HEALTH ON CARE OF URETHRAL STRICTURES: A PILOT EVALUATION OF THE AREA DEPRIVATION INDEX Evan Watkins, Abimbola Ayangbesan, George Koch, Rohan Bhalla, Jackson Cabo, Helen Gambrah, Theresa Zwaschka, and Niels Johnsen Evan WatkinsEvan Watkins More articles by this author , Abimbola AyangbesanAbimbola Ayangbesan More articles by this author , George KochGeorge Koch More articles by this author , Rohan BhallaRohan Bhalla More articles by this author , Jackson CaboJackson Cabo More articles by this author , Helen GambrahHelen Gambrah More articles by this author , Theresa ZwaschkaTheresa Zwaschka More articles by this author , and Niels JohnsenNiels Johnsen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003325.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Living in socioeconomically disadvantaged neighborhoods affects health behaviors and outcomes. How neighborhood disadvantage impacts care of benign urologic disease has not been previously studied. In this pilot study, we sought to evaluate how patient-level social risk determinants impact care of urethral stricture patients. METHODS: Patients treated with urethroplasty between 9/4/2019 and 12/29/2021 were analyzed. Those with a history of urethroplasty and under the age of 18 were excluded. To evaluate neighborhood disadvantage, we used the area deprivation index (ADI), a 17-component index composed of education, employment, housing-quality, and poverty measures utilizing data from the American Community Survey. Patient addresses were geocoded and assigned a national ADI rank, with scores normalized to a percentile from 0 to 100, with higher numbers representing higher levels of disadvantage. For this analysis, patients were grouped into ADI quartiles. Multiple endoscopic procedures was defined as >2 procedures prior to urethroplasty. Impact of ADI on treatment and processes of care was analyzed utilizing univariate and multivariate models. RESULTS: 104 patients were included, with a median age 54.5 (IQR 38, 66) and ADI of 63.5 (IQR 38.8, 79.3). When separated into quartiles, 15.4%, 21.2%, 31.7% and 31.7% were in the first, second, third and fourth ADI quartiles, respectively, with higher quartiles representing increased levels of deprivation. There were no significant differences in race or insurance status by ADI quartile. Patients in the highest ADI quartile underwent significantly more endoscopic procedures prior to urethroplasty than those in the lowest, at 0 (0, 1) versus 2 (1, 4) (p=0.01). On multivariate analysis adjusting for age and insurance status, ADI quartile was associated with an increased likelihood of undergoing multiple endoscopic procedures, with OR 4.97 (95% CI 1.22-26.14) and OR 5.05 (95% CI 1.23 – 26.53) for third and fourth quartiles, respectively. A one-point increase in ADI was associated with a 2% increased risk of repeat endoscopic procedures prior to urethroplasty (OR 1.02 [95% CI 1.01 – 1.04]). CONCLUSIONS: This is the first analysis evaluating how a patient’s physical neighborhood can mediate processes of care for urethral stricture disease. We found that increased neighborhood deprivation, regardless of race or insurance status, can lead to increased endoscopic treatments and delays to urethroplasty. Utilization of this methodology can help further identify disparities in care and highlight the impact of social determinants on urologic care. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e911 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Evan Watkins More articles by this author Abimbola Ayangbesan More articles by this author George Koch More articles by this author Rohan Bhalla More articles by this author Jackson Cabo More articles by this author Helen Gambrah More articles by this author Theresa Zwaschka More articles by this author Niels Johnsen More articles by this author Expand All Advertisement PDF downloadLoading ...

Neighbourhood deprivation across eight decades and late-life cognitive function in the Lothian Birth Cohort 1936: a life-course study.

although neighbourhood may predict late-life cognitive function, studies mostly rely on measurements at a single time point, with few investigations applying a life-course approach. Furthermore, it is unclear whether the associations between neighbourhood and cognitive test scores relate to specific cognitive domains or general ability. This study explored how neighbourhood deprivation across eight decades contributed to late-life cognitive function. data were drawn from the Lothian Birth Cohort 1936 (n = 1,091) with cognitive function measured through 10 tests at ages 70, 73, 76, 79 and 82. Participants' residential history was gathered with 'lifegrid' questionnaires and linked to neighbourhood deprivation in childhood, young adulthood and mid-to-late adulthood. Associations were tested with latent growth curve models for levels and slopes of general (g) and domain-specific abilities (visuospatial ability, memory and processing speed), and life-course associations were explored with path analysis. higher mid-to-late adulthood neighbourhood deprivation was associated with lower age 70 levels (β = -0.113, 95% confidence intervals [CI]: -0.205, -0.021) and faster decline of g over 12years (β = -0.160, 95%CI: -0.290, -0.031). Initially apparent findings with domain-specific cognitive functions (e.g. processing speed) were due to their shared variance with g. Path analyses suggested that childhood neighbourhood disadvantage is indirectly linked to late-life cognitive function through lower education and selective residential mobility. to our knowledge, we provide the most comprehensive assessment of the life-course neighbourhood deprivation and cognitive ageing relationship. Living in advantaged areas in mid-to-late adulthood may directly contribute to better cognitive function and slower decline, whereas an advantaged childhood neighbourhood likely affects functioning through cognitive reserves.

409 Effect of Social Determinants of Health on Post-Discharge Adverse Outcomes After Surgical Resection of Meningioma

INTRODUCTION: Understanding the role of social determinants of health (SDoH) is critical in informing preoperative care and postoperative follow-up for meningioma patients undergoing surgery. METHODS: A retrospective cohort study of adults presenting for meningioma resection from 1999-2020 was conducted. Primary outcomes included recurrence, readmission, and LTF (6-month and total). The main exposure of interest was Area Deprivation Index (ADI), a composite score of socioeconomic disadvantages. Additional SDoH factors analyzed included drive time to the hospital, insurance, and race. Multivariable logistic regression analyses for LTF and Cox regression for recurrence- and readmission-free survival were conducted. Covariates included age, WHO grade, and extent of resection. RESULTS: In total, 736 patients were included. Recurrence was observed in 90 patients, and 99 patients were readmitted following discharge. 121 patients missed initial and 6-month follow-up, but 107 of those eventually followed-up after six months. Fourteen patients were entirely LTF. ADI (OR = 1.11 per 10-point increase, 95% CI 1.02-1.21, p = 0.017) and drive time (OR = 1.03 per 30-minute increase, 95% CI 1-1.06, p = 0.022) predicted 6-month LTF. Drive time predicted complete LTF (OR = 1.04 per 30-minute increase, 95% CI 1-1.07, p = 0.017). Medicare/Military insurance predicted lower recurrence risk (HR = 0.43, 95% CI 0.23-0.81, p = 0.009) and higher readmission risk (HR = 2.00, 95% CI 1.17-3.41, p = 0.011). Other SDoH factors were not associated with recurrence or readmission. Lower WHO grade predicted lower recurrence risk (HR = 0.5, 95% CI 0.33-0.78, p = 0.002), while age (HR = 0.75 per 10-year increase, 95% CI 0.62-0.89, p &lt; 0.001) and gross total resection (HR = 0.56, 95% CI 0.35-0.9, p = 0.016) predicted lower readmission risk. CONCLUSIONS: Socioeconomically disadvantaged neighborhoods and further distance from the hospital were barriers to follow-up after meningioma resection. Other SDoH associated with readmission and recurrence are reported. Individualized follow-up plans should consider these SDoH to ensure care continuity and improve outcomes.

Neighborhood Incarceration Rates and Adverse Birth Outcomes in New York City, 2010-2014

The US has high rates of adverse birth outcomes, with substantial racial disparities augmented by stress and neighborhood disadvantage. Black people are more likely to live in neighborhoods with high rates of incarceration, which is a source of both stress and neighborhood disadvantage and, thus, may contribute to adverse birth outcomes. To determine whether neighborhoods with high incarceration rates also have higher rates of adverse birth outcomes compared with neighborhoods with lower rates. This cross-sectional study used publicly available data from the New York City Department of Health (2010-2014). Censored Poisson regression, with the US Census tract as the unit of analysis, was used to examine the association of neighborhood incarceration rate and birth outcomes. Multivariable models included percentage of births aggregated to the Census tract by maternal factors (age, parity, singleton vs multiple birth, insurance, and race) and neighborhood factors (poverty, education, and violent crime). Analyses were performed between May 2021 and October 2022. Neighborhood incarceration rate, categorized into quintiles. The primary outcome was the incidence rate ratio (IRR) of preterm birth and low birth weight. Secondary outcomes were IRRs of very preterm birth, extremely preterm birth, and very low birth weight. Hypotheses were formulated before data collection. Among 2061 Census tracts with 562 339 births, incarceration rates varied from 0 to 4545 people incarcerated per 100 000, and high-incarceration neighborhoods had more residents of Black race (54.00% vs 1.90%), living in poverty (32.30% vs 10.00%), and without a general educational development equivalent (28.00% vs 12.00%) compared with low-incarceration neighborhoods. In fully adjusted models, high-incarceration neighborhoods had a 13% higher IRR of preterm birth (IRR, 1.13; 95% CI, 1.08-1.18), 45% higher IRR of very preterm birth (IRR, 1.45; 95% CI, 1.24-1.71), 125% higher IRR of extremely preterm birth (IRR, 2.25; 95% CI, 1.59-3.18), 10% higher IRR of low birth weight (IRR, 1.10; 95% CI, 1.05-1.16), and 52% higher IRR of very low birth weight compared with low-incarceration neighborhoods (IRR, 1.52; 95% CI, 1.28-1.81). Neighborhood incarceration rate was positively associated with adverse birth outcomes, particularly those associated with infant mortality. Black people were significantly more likely to live in high-incarceration neighborhoods, suggesting that mass incarceration may contribute to racial disparities in birth outcomes.

Neighbourhood socio-economic disadvantage and loneliness: the contribution of green space quantity and quality

Disadvantaged areas experience higher levels of loneliness than advantaged areas, though studies rarely identify environmental determinants of neighbourhood inequity in loneliness. We studied the contribution of the quantity and quality of green space to neighbourhood inequity in loneliness in three buffer sizes (400 m, 800 m, 1600 m), using cross-sectional data from 3778 individuals aged 48–77 years old living in 200 neighbourhoods in Brisbane, Australia. Levels of loneliness were significantly higher in disadvantaged neighbourhoods, and these neighbourhoods had less green space and less access to quality green space. However, there was no evidence that neighbourhood disparities in green space contributed to the association between neighbourhood disadvantage and loneliness. Possible methodological and substantive reasons for this result are discussed.

Perceived neighborhood disorder as a moderator of the relationship between marijuana use and disinhibition in a sample of emerging adult African American females

Disinhibition is associated with myriad risk-taking behaviors and adverse outcomes. Both marijuana use and poor neighborhood conditions have been associated with disinhibition. However, the extent to which neighborhood disorder interacts with marijuana use to influence disinhibition has not been studied, extensively. A better understanding of these relationships has implications for designing more effective tailored place-based interventions that aim to reduce risk taking behaviors and related adverse social and health outcomes associated with marijuana use. Thus, the purpose of this study was to examine the interactive effects of perceived neighborhood disorder and marijuana use on disinhibition. The sample included 120 African American female residents of disadvantaged neighborhoods (Mage = 23.6 ± 3.46). We employed hierarchical linear regression analysis to examine the interactive effects of marijuana use and perceived neighborhood disorder on disinhibition, while controlling for age and education. The interaction term was marginally significant (b = 5.66; t(109) = 1.72, p = .08). Next, the conditional effects were explored. Results indicated the association of marijuana use with disinhibition was stronger for females in the higher neighborhood disorder group, compared to those in the lower neighborhood disorder group (10.40 and 4.51, respectively). Our findings support the need for more research on the potential of neighborhood disorder to amplify the effects of marijuana use on disinhibition and related neurobehavioral traits. The identification of contextual moderators and high-risk sub-groups will aid in the design of more tailored place-based interventions that aim to reduce risk-taking behavior among those most vulnerable.

Reducing the number and types of tobacco retail outlets in the Netherlands: Study protocol for a comprehensive mixedmethods policy evaluation.

Clinical Trials ID NCT05554120, Protocol ID KWF140282021-2. FOIA: Freedom of Information Act. SES-WOA: socioeconomic scores of private households. MCID: minimal clinically important difference.

Stroke Severity Mediates the Association Between Socioeconomic Disadvantage and Poor Outcomes Among Patients With Acute Ischemic Stroke

Background Impact of mediating factors on the relationship between socioeconomic disadvantage and outcomes among patients with acute ischemic stroke has not been well characterized. Methods Data on patients with acute ischemic stroke were extracted from electronic medical records, and 90‐day modified Rankin scale (mRS) scores were collected as part of a prospective stroke registry. Exact patient addresses were geocoded and characterized using Area Deprivation Index (ADI) ranks. The 90‐day modified Rankin scale scores ≥3 were categorized as poor outcomes. Logistic regression models (adjusted for treatment with intravenous tissue plasminogen activator or intraarterial therapy, sociodemographics, and comorbidities) were fitted to compute adjusted odds ratios (aORs) and 95% CIs for total effect of high ADI on poor outcomes. In‐hospital mortality (versus survived) and unfavorable (versus favorable) discharge disposition were also evaluated as outcomes. Structural equation modeling was used to report the average causal mediation effects of stroke severity (National Institutes of Health Stroke Scale [NIHSS]) and treatment (intravenous tissue plasminogen activator or intraarterial therapy). Results Between May 2016 and December 2021, 13 641 patients with acute ischemic stroke (median age, 69 years; 50.1% women) were included. Among 3002 patients with functional outcomes data, a high ADI was significantly associated with poor 90‐day modified Rankin scale score (aOR, 1.16 [95% CI, 1.04–1.29]). Patients in higher ADI neighborhoods had increased odds of having higher NIHSS scores (aOR, 1.19 [95% CI, 1.07–1.32]). Likewise, a higher NIHSS score was associated with poor 90‐day modified Rankin scale score (aOR, 9.34 [95% CI, 7.64–11.5]). The effect of neighborhood disadvantage on poor 90‐day modified Rankin scale score was 59% mediated by NIHSS score (average causal mediation effects: P &lt;0.001). NIHSS score also accounted for 93% of the pathway for unfavorable discharges. In‐hospital mortality was not associated with ADI, and treatment did not significantly mediate any outcomes. Conclusions Neighborhood disadvantage leads to unfavorable hospital discharges and worse 90‐day disability, mediated via stroke severity. Tracking social determinants of health may identify opportunities for reducing the onset of severe strokes and poor outcomes.

Neighborhood disadvantage and health-related quality of life in pediatric epilepsy

IntroductionWhile several demographic and epilepsy-specific characteristics are associated with diminished HRQoL in children and adolescents with epilepsy, prior investigations have failed to incorporate and address the influence of broader social contextual factors on functional outcomes. To address this gap, the purpose of the current study was to investigate the role of neighborhood disadvantage on HRQoL, including the extent to which familial and seizure-specific risk factors are impacted. MethodsData included parental ratings on the Quality of Life in Childhood Epilepsy (QOLCE) questionnaire for 135 children and adolescents with epilepsy, and the Area Deprivation Index (ADI) to measure neighborhood disadvantage. Bivariate correlations were conducted to identify significant associations with neighborhood disadvantage, followed by a three-stage hierarchical multiple regression to predict HRQoL. Follow-up binary logistic regressions were used to determine the risk conferred by neighborhood disadvantage on sociodemographic, seizure-specific, and HRQoL factors. ResultsModerate associations between neighborhood disadvantage and familial factors, including parental psychiatric history and Medicaid insurance, were identified, while disadvantage and greater seizure frequency were marginally associated. Neighborhood disadvantage independently predicted HRQoL, and was the sole significant predictor of HRQoL when familial factors were incorporated. Children with epilepsy living in disadvantaged areas were four times more likely to have diminished HRQoL, five times more likely to live with a parent with a significant psychiatric history, and four times more likely to reside with a family receiving Medicaid insurance. ConclusionsThese results highlight the importance of identifying high-risk groups, as the cumulative burden of social context, familial factors, and seizure-specific characteristics contribute to lower HRQoL in pediatric epilepsy which disproportionately affects patients from lower-resourced backgrounds. Potentially modifiable factors such as parental psychiatric status exist within the child’s environment, emphasizing the importance of a whole-child approach to patient care. Further exploration of disadvantage in this population is needed to better understand these relationships over time.

Development Fees and Park Equity in Los Angeles

Problem, research strategy, and findings Parks are inequitably distributed in many U.S. cities, and policies and planning initiatives around the country have sought to rectify these inequities. In this study, we examined whether one such initiative, a policy change in development fees for parks in Los Angeles (CA), achieved its equity goals. Specifically, the changed Park Fees Ordinance loosened the distance requirements between developments where fees are collected and parks where fees can be invested to create opportunities to spend funds in disadvantaged neighborhoods with little development. We examined whether disadvantaged communities received more park fees after the policy change in 2017. We found no significant equity gains based on socioeconomic status, some gains for non-Hispanic Black people, but some losses for Latinx people. We attribute these findings to a lack of equity criteria in the policy, political pressures, capital renovations to address deferred maintenance, and geographic limitations in where funds can be spent. We also found that Los Angeles seemed to have taken advantage of the increased geographic flexibility in the changed policy, although a lack of data linking fee-generating developments to fee-receiving parks limited the certainty of this finding. Takeaway for practice Park fees are not a panacea to advance park equity. Yet park fee policies could include measurable equity criteria to help direct some funds to disadvantaged park-poor communities while leaving some funds to the discretion of elected officials. Also, cities should have transparent data about the generation and distribution of park fees.

Effects of Te Ara Mua – Future Streets suburban street retrofit on traffic speed and volume: Controlled before-after study

BackgroundTraffic speed and volume are important determinants of road traffic injury rates for all travel modes, and high traffic speed and volume can deter walking and cycling. Te Ara Mua – Future Streets is a project in Māngere, Aotearoa New Zealand, that aims to make it safer and easier for people to get around their local neighbourhood, especially by walking and cycling. Key components include implementation of a street hierarchy and street design changes to reduce speeds on neighbourhood streets, as well as other components including improved active transport infrastructure. MethodsWe used tube counters to measure motor vehicle speed and volume before and after the intervention, at different levels of the street hierarchy: arterial, collector and local streets. A difference-in-differences approach was used to assess changes in the intervention area compared with a matched control area. ResultsWe found post-intervention mean speed reductions of 8 km/h on local streets, and 5–6 km/h on collector streets, relative to the control area. Mean traffic volumes reduced by 17–24% on local streets, with no change on collectors or arterials. Both post-intervention time points showed similar results, indicating a sustained effect. ConclusionsOverall, this intervention successfully reinforced a street hierarchy, creating local residential streets that are more conducive to road safety and active travel. Implementation of similar interventions in disadvantaged neighbourhoods could help reduce road traffic injury inequities within cities. The findings suggest a promising contribution to safer streets that are more attractive for walking and cycling. Our future research will evaluate broader impacts of this intervention on travel mode shift, injury rates and other health and social outcomes.

Area deprivation index and segregation on the risk of HIV: a U.S. Veteran case–control study

Preventing HIV infection remains a critically important tool in the continuing fight against HIV/AIDS. The primary aim is to evaluate the effect and interactions between a composite area-level social determinants of health measure and an area-level measure of residential segregation on the risk of HIV/AIDS in U.S. Veterans. Using the individual-level patient data from the U.S. Department of Veterans Affairs, we constructed a case-control study of veterans living with HIV/AIDS (VLWH) and age-, sex assigned at birth- and index date-matched controls. We geocoded patient's residential address to ascertain their neighborhood and linked their information to two measures of neighborhood-level disadvantage: area deprivation index (ADI) and isolation index (ISOL). We used logistic regression to estimate the odds ratio (OR) and 95% confidence interval (CI) for comparing VLWH with matched controls. We performed analyses for the entire U.S. and separately for each U.S. Census division. Overall, living in minority-segregated neighborhoods was associated with a higher risk of HIV (OR: 1.88 (95% CI: 1.79-1.97) while living in higher ADI neighborhoods was associated with a lower risk of HIV (OR: 0.88; 95% CI: 0.84-0.92). The association between living in a higher ADI neighborhood and HIV was inconsistent across divisions, while living in minority-segregated neighborhoods was consistently associated with increased risk across all divisions. In the interaction model, individuals from low ADI and high ISOL neighborhoods had a higher risk of HIV in three divisions: East South Central; West South Central, and Pacific. Our results suggest that residential segregation may prevent people in disadvantaged neighborhoods from protecting themselves from HIV independent from access to health care. There is the need to advance knowledge about the neighborhood-level social-structural factors that influence HIV vulnerability toward developing interventions needed to achieve the goal of ending the HIV epidemic. US National Cancer Institute.

Racial, ethnic and neighborhood socioeconomic differences in incidence of dementia: A regional retrospective cohort study.

Evidence on the effects of neighborhood socioeconomic disadvantage on dementia risk in racially and ethically diverse populations is limited. Our objective was to evaluate the relative extent to which neighborhood disadvantage accounts for racial/ethnic variation in dementia incidence rates. Secondarily, we evaluated the spatial relationship between neighborhood disadvantage and dementia risk. In this retrospective study using electronic health records (EHR) at two regional health systems in Northeast Ohio, participants included 253,421 patients aged >60 years who had an outpatient primary care visit between January 1, 2005 and December 31, 2015. The date of the first qualifying visit served as the study baseline. Cumulative incidence of composite dementia outcome, defined as EHR-documented dementia diagnosis or dementia-related death, stratified by neighborhood socioeconomic deprivation (as measured by Area Deprivation Index) was determined by competing-risk regression analysis, with non-dementia-related death as the competing risk. Fine-Gray sub-distribution hazard ratios were determined for neighborhood socioeconomic deprivation, race/ethnicity, and clinical risk factors. The degree to which neighborhood socioeconomic position accounted for racial/ethnic disparities in the incidence of composite dementia outcome was evaluated via mediation analysis with Poisson rate models. Increasing neighborhood disadvantage was associated with increased risk of EHR-documented dementia diagnosis or dementia-related death (most vs. least disadvantaged ADI quintile HR=1.76, 95% confidence interval=1.69-1.84) after adjusting for age and sex. The effect of neighborhood disadvantage on this composite dementia outcome remained after accounting for known medical risk factors of dementia. Mediation analysis indicated that neighborhood disadvantage accounted for 34% and 29% of the elevated risk for composite dementia outcome in Hispanic and Black patients compared to White patients, respectively. Neighborhood disadvantage is related to the risk of EHR-documented dementia diagnosis or dementia-related death and accounts for a portion of racial/ethnic differences in dementia burden, even after adjustment for clinically important confounders.

Assessing the spatial distribution of and inequality in 15-minute PCR test site accessibility in Beijing and Guangzhou, China

China has been planning to construct SARS-CoV-2 antigen testing sites within a 15-min walk in most major cities to timely identify asymptomatic cases and stop the transmission of COVID-19. However, little is known about the spatial distribution of 15-min accessibility to PCR test sites. In this study, we analyze the spatial distribution of and inequality in 15-min accessibility to PCR test sites in two major Chinese cities (Beijing and Guangzhou) based on the cumulative-opportunity model. The results indicate that the current distribution of 15-min accessibility to PCR test sites is satisfactory when normal commuting is not disrupted. However, disruptions of normal commuting (e.g., due to work-from-home restrictions) can negatively influence 15-min accessibility to PCR test sites and increase its inequality. Our study provides policymakers with up-to-date knowledge about the spatial distribution of 15-min accessibility to PCR test sites, identifies the disadvantaged neighborhoods in terms of test site accessibility, and highlights the changes in accessibility and inequality because of travel disruptions.

Berlin Pankow: a 15-min city for everyone? A case study combining accessibility, traffic noise, air pollution, and socio-structural data

Cars are dominating urban traffic in cities around the world, even though daily trips in many cities are often realized with active modes of transportation or public transport. Urban transport planning processes need to adapt to this reality and the necessity of climate change mitigation. Against this background, the research project “Mobility Reporting”, a joint undertaking of the district Pankow in Berlin and researchers from TU Berlin and TU Dresden, established a new, goal-driven, and participative planning process. The process identified local mobility as one of the central planning goals. The 15-min city (FMC) was thus adduced as a benchmark to analyze the district’s current mobility system and development potential. We conducted extensive accessibility analyses to examine the status quo concerning the FMC. We calculated travel times to essential destinations in daily life by foot, public transport, and car. This analysis was accompanied by a mixed online and paper–pencil survey conducted to evaluate the perceived accessibility of people in Pankow. The survey results shed light on the question of which walking time thresholds constitute a “very good” or “good” accessibility. Further analyses included environmental and social variables, allowing us to check whether areas with different accessibility levels also differ regarding the socio-economic characteristics of their inhabitants. For example, do socially advantaged neighborhoods have better local accessibility? Is there a trade-off between exposure to environmental pollution and good accessibility? With this contribution, we shed light on what an FMC is and ought to be. Results from the survey support the normative and political vision of the FMC. Pankow generally offers the merits of a walkable city, showing the expected travel time differences between the dense inner city and the outskirts. Socially disadvantaged neighborhoods are not consistently less accessible. However, there seems to be a trade-off between good accessibility (especially PT accessibility) and correlated externalities of transport, namely air pollution and noise.

Associations of time spent gardening with mental wellbeing and life satisfaction in mid-to-late adulthood

There is relatively limited research investigating the mental health benefits of gardening. In this cross-sectional study, survey data from 4,919 middle-aged and older adults (46–80 years, 57% women) from Brisbane, Australia, were used to examine the associations of time spent gardening (0, 1–149 or ≥150 min/week) with indicators of mental wellbeing (measured with the Short Warwick-Edinburgh Mental Wellbeing scale) and singe-item measure of life satisfaction. We also investigated whether such associations differed between younger and older age groups (≤63 years and >64 years). Multilevel linear regression models were used to control for individual- and area-level confounders (e.g., gender, neighbourhood disadvantage). Of all participants, 37% reported no gardening, 42% reported gardening for 1–149 min weekly, and 21% reported ≥150 min of weekly gardening. Compared to participants who did not engage in gardening, those who gardened for ≥150 min per week were more likely to report better mental wellbeing (β = 0.64, 95% CI [0.35, 0.93], p < .001; range 7–35) and life satisfaction (β = 0.33, 95% CI [0.18, 0.48], p <. 001; range 1–10). Stratified analyses revealed that these effects were stronger for participants aged 64 years and older. These findings contribute to a burgeoning body of research that indicates gardening may be beneficial for mental health and life satisfaction, that gardening for at least 2.5 hrs per week is linked with better mental health outcomes, and that gardening may be particularly beneficial for older adults.

Disparities in 30-day readmission rates among Medicare enrollees with dementia.

Readmissions contribute to excessive care costs and burden for people living with dementia. Assessments of racial disparities in readmissions among dementia populations are lacking, and the role of social and geographic risk factors such as individual-level exposure to greater neighborhood disadvantage is poorly understood. We examined the association between race and 30-day readmissions in a nationally representative sample of Black and non-Hispanic White individuals with dementia diagnoses. This retrospective cohort study used 100% Medicare fee-for-service claims from all 2014 hospitalizations nationwide among Medicare enrollees with dementia diagnosis linked to patient, stay, and hospital factors. The sample consisted of 1,523,142 hospital stays among 945,481 beneficiaries. The relationship between all cause 30-day readmissions and the explanatory variable of self-reported race (Black, non-Hispanic White) was examined via generalized estimating equations approach adjusting for patient, stay, and hospital-level characteristics to model 30-day readmission odds. Black Medicare beneficiaries had 37% higher readmission odds compared to White beneficiaries (unadjusted OR 1.37, CI 1.35-1.39). This heightened readmission risk persisted after adjusting for geographic factors (OR 1.33, CI 1.31-1.34), social factors (OR 1.25, CI 1.23-1.27), hospital characteristics (OR 1.24, CI 1.23-1.26), stay-level factors (OR 1.22, CI 1.21-1.24), demographics (OR 1.21, CI 1.19-1.23), and comorbidities (OR 1.16, CI 1.14-1.17), suggesting racially-patterned disparities in care account for a portion of observed differences. Associations varied by individual-level exposure to neighborhood disadvantage such that the protective effect of living in a less disadvantaged neighborhood was associated with reduced readmissions for White but not Black beneficiaries. Conversely, among White beneficiaries, exposure to the most disadvantaged neighborhoods associated with greater readmission rates compared to White beneficiaries residing in less disadvantaged contexts. There are significant racial and geographic disparities in 30-day readmission rates among Medicare beneficiaries with dementia diagnoses. Findings suggest distinct mechanisms underlying observed disparities differentially influence various subpopulations.